Post-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer
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1 Post-Induction PET Does Not Correlate with Persistent Nodal Disease or Overall Survival in Surgically Treated Stage IIIA Non-Small Cell Lung Cancer R. Taylor Ripley, Kei Suzuki, Kay See Tan, Manjit Bains, Prasad Adusumilli, James Huang, Bernard J. Park, Robert J. Downey, Nabil P. Rizk, Valerie W. Rusch, David R. Jones Memorial Sloan-Kettering Cancer Center 95 th Annual Meeting, American Association for Thoracic Surgery
2 No Conflicts of Interest
3 Overall Survival Post-Induction PET Does Not Correlate with Persistent N2 Disease Induction Chemotherapy Improves Survival in Surgically Resected Stage IIIA NSCLC 34% 3 Year Overall Survival 7% 3 year Overall Survival Years Martini. Ann Thorac Surg 1993; 55(6):
4 Post-Induction PET Nodal Assessment Restaging the mediastinum by PET has reported false negative rates of 23 36% and false positive rates of 25 40%. However, these studies were small, some evaluated PET only, did not reliably stage N2 disease, and inconsistent and poorly documented mediastinal lymph node dissections. Candela and Detterbeck. J Thoracic Oncol 2010; 5:
5 Aim We examined whether post-induction PET scans correlated with pathological downstaging for patients with clinical Stage IIIA disease with pathologically confirmed N2 disease and complete mediastinal lymph node dissections. In addition, we examined overall and disease-free survival in this highly selected group of patients.
6 Methods Retrospective Review: Retrospective cohort study using an institutional prospectively maintained institutional surgical database Inclusion Criteria: Clinical Stage IIIA / pn2 NSCLC Induction Chemotherapy (98% Platinum-based) Pre-Induction Pathological Confirmation of N2 disease Exclusion Criteria: Induction Chemoradiotherapy Synchronous Lesions Superior Sulcus Tumors Neuroendocrine Tumors
7 Primary Endpoint: Study Objectives Post-induction PET prediction of pathological nodal downstaging Secondary Endpoints: 30- and 90-day Mortalities Disease-Free Survival Overall Survival Recurrence Patterns
8 Results Demographics: 101 Consecutive Patients from 2007 until % Former or Current Smokers PET Scans: 99% Pre-Induction Scans 81% Post-induction Scans Operative Details: 82% Lobectomy / Bilobectomy 8% Pneumonectomy 10% Sublobar Resection Mortality: 2% (2 patients) 30- and 90-day Mortality. Adult Respiratory Distress Syndrome after Lobectomy and Segmentectomy
9 Results: Pathological Staging Post-Induction Pathological Stage 0 2% I 25% II 9% IIIA 59% IIIB 3% IV 2% Pathological N Status N0 33% N1 7% N2 60% 36% 40%
10 No Correlation Between PET Negativity and ypn2 Mediastinum on Post-Induction PET Scans were Negative in 45% of Patients 51% (19/37) ypn2 Disease 49% (18/37) <ypn2 Disease
11 No Correlation between Mediastinal Downstaging and PET Results Pathological Downstaging (ypn0 or 1) 50% (14/28) Positive PET in Mediastinum 50% (14/28) Negative PET in Mediastinum
12 Overall Survival after Induction Chemotherapy for Stage IIIA NSCLC 44%
13 Post-Induction Mediastinal Assessment by PET Does Not Correlate With Overall Survival 56% PET Negative 50% PET Positive P = 0.35
14 Overall Survival was Similar Regardless of Pathological Downstaging 52% Pathological IIIA 46% Pathological IA-IIB P = 0.81
15 Overall Survival was Similar Regardless of Post- Induction Pathological N Status 45% OS ypn0 50% OS ypn1 52% OS ypn2 P = 0.99
16 Disease-Free Survival was Improved with Pathological Downstaging 43% Pathological IA - IIB P = % Pathological IIIA
17 Limitations Unknown denominator of patients with Stage IIIA disease who were not offered resection. Lack of uniform data on PET scans; however the study reflects current practice patterns. Unable to determine single versus multistation disease.
18 Conclusions Post-induction N2 assessment by PET does not correlate with pathological downstaging. Post-induction mediastinal nodal assessment by PET did not correlate with overall survival. Disease-free survival, not overall survival, correlated with persistent ypn2 disease.
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