gms | German Medical Science

Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie

24.-26.10.2013, Basel, Schweiz

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Clinical Significance of Nodal Stage Migration in Lung Cancer – Data from a VATS Lobectomy Cohort

Meeting Abstract

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  • F. Augustin - Univ.-Klinik f. Visceral-, Transplantations- u. Thoraxchirurgie, Medizinische Universität Innsbruck (MUI), Innsbruck
  • H. Maier - Univ.-Klinik f. Visceral-, Transplantations- u. Thoraxchirurgie, Medizinische Universität Innsbruck (MUI), Innsbruck
  • P. Lucciarini - Univ.-Klinik f. Visceral-, Transplantations- u. Thoraxchirurgie, Medizinische Universität Innsbruck (MUI), Innsbruck
  • J. Bodner - Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Gießen; Univ.-Klinik f. Visceral-, Transplantations- u. Thoraxchirurgie, Medizinische Universität Innsbruck (MUI), Innsbruck
  • J. Pratschke - Univ.-Klinik f. Visceral-, Transplantations- u. Thoraxchirurgie, Medizinische Universität Innsbruck (MUI), Innsbruck
  • T. Schmid - Univ.-Klinik f. Visceral-, Transplantations- u. Thoraxchirurgie, Medizinische Universität Innsbruck (MUI), Innsbruck

Deutsche Gesellschaft für Thoraxchirurgie. Österreichische Gesellschaft für Thoraxchirurgie. Schweizerische Gesellschaft für Thoraxchirurgie. Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie. Basel, Schweiz, 24.-26.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP14

doi: 10.3205/13dgt066, urn:nbn:de:0183-13dgt0663

Veröffentlicht: 14. Oktober 2013

© 2013 Augustin et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

Text

Objective: To compare clinical nodal staging with pathological staging after VATS lobectomy and define its clinical significance.

Methods: Retrospective analysis of a prospectively maintained database.

Results: Between 2009 and 2012, 191 patients with lung cancer were scheduled for primary VATS lobectomy. Clinical staging was PET/CT scan in all patients and EBUS-TBNA or mediastinoscopy in patients with PET positive or enlarged mediastinal lymph nodes in the CT scan (29 patients, 15.2%). Clinical and pathologic nodal staging were identical in 127 patients (66.4%). Nodal downstaging occurred in 35 patients (18.3%). Nodal upstaging was found in 29 patients (15.3%); in patients with clinical N0 disease (cN0), pathologic workup revealed N1 disease in 15 patients and N2 disease in 10. In patients with clinical N1 disease, N2 positive lymph nodes were found in 4 patients. T-stage changed in 20 patients. In pN0 patients, survival and rate of tumor recurrence did not differ between patients with nodal downstaging (cN+pN0) and clinically nodal negative (cN0pN0) patients (p=0.2246; 15.6 vs. 10.6%, p=0.5239). Tumor recurrence rate was 13.3% for clinically nodal positive patients (cN+pN+) and 38% for patients with nodal upstaging (cN0pN+), p=0.1624. There was no difference in survival between these groups (p=0.2830). Sensitivity and specificity of clinical nodal staging was 0.301 and 0.765, respectively. Positive and negative predictive value was 0.271 and 0.797, respectively. Accuracy was 66.5%.

Conclusion: Accuracy of clinical nodal staging with PET/CT is low. Nodal downstaging did not translate into inferior survival, indicating a proper surgical lymph node staging. We found nodal tumor invasion in 18% of patients with nodal negative clinical staging. Adjuvant therapy was indicated for all these patients. Low sensitivity of PET/CT is a pitfall for noninvasive local treatment strategies for clinically nodal negative patients. We therefore advocate surgical therapy including nodal dissection for all patients with appropriate fitness for surgery.