Predictive Value of Preoperative PET/CT in Resectable Clinical N0 Non-small Cell Lung Cancer

SESSION TITLE: Lung Cancer: Imaging SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: The aim of this study was to analyze the prognostic impact of preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) on pathological nodal involvement and long-term survival in patients with completely resected clinical (c-) N0 non-small cell lung cancer (NSCLC). METHODS: We retrospectively reviewed 255 patients with cN0 NSCLC who underwent 18F-FDG PET/CT scan before surgical resection from January 2005 to January 2015. Clinicopathological factors were evaluated to identify the independent factors predicting pathological nodal involvement by univariate and multivariate analysis. The survivals were calculated by the Kaplan-Meier method and differences in variables were analyzed by the Log-rank test in univariate analysis and the Cox proportional hazards model in multivariate analysis. RESULTS: Of the 255 cN0 NSCLC patients, 217 (85.1%) had pathological N0 status and 38 (14.9%) had pathological lymph node metastasis. Univariate analyses found a significant association between occult nodal involvement and tumor size (p = 0.021), SUVmax of the primary tumor (p < 0.001), lymphovascular invasion (LVI) (p < 0.001), visceral pleural invasion (VPI) (p < 0.001), and number of removed nodes (p = 0.001); Multivariate analysis demonstrated the LVI (P< 0.001), VPI (P = 0.009), and maximum standardized uptake value (SUVmax) (P = 0.003) were significant predictors of occult nodal involvement. Patients with higher SUVmax had significantly worse overall survival than those with lower SUVmax in univariate analysis. SUVmax and LVI was found to be independent prognostic factors according to multivariate analysis (P=0.036 and P=0.033, respectively). CONCLUSIONS: The SUVmax of primary tumor was independent predictor of occult nodal involvement and survival after surgery for cN0 NSCLC. Therefore, it can contribute to accuracy staging, risk stratification, and selecting the optimal therapeutic strategy. CLINICAL IMPLICATIONS: This promising noninvasive biomarker regarding tumor aggressive behavior could be available before surgery and enable us to identify patients at high risk of potential nodal involvement. Patients with high SUVmax should be considered for accuracy staging and intensive treatment in order to improve survival outcomes. DISCLOSURE: The following authors have nothing to disclose: Guangliang Qiang, Rui Xu, Qiduo Yu, Fei Xiao, Zhiyi Song, Yanchu Tian, Bin Shi, Chaoyang Liang, Yongqing Guo, Deruo Liu No Product/Research Disclosure Information