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Title: Long-term survival of 42 patients with resected N2 non-small-cell lung cancer: the impact of 2-(18)F-fluoro-2-deoxy-D-glucose positron emission tomogram mediastinal staging.
Austin Authors: Barnett, Stephen A ;Baste, Jean-Marc;Murugappan, Kowsi;Tog, Check;Berlangieri, Salvatore U ;Scott, Andrew M ;Seevanayagam, Siven ;Knight, Simon R 
Affiliation: Department of Thoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Jul-2010
Publication information: European Journal of Cardio-thoracic Surgery : Official Journal of the European Association For Cardio-thoracic Surgery 2010; 39(1): 96-101
Abstract: Prognostic information known preoperatively allows stratification of patients to surgery; induction therapy and surgery; or definitive chemoradiotherapy and may prevent a futile thoracotomy. Attention has focussed on the standard uptake value (SUV) of the primary tumour but less has been described regarding the 18F-fluoro-2-deoxy-D-glucose (18F-FDG) avidity of mediastinal nodes. We aimed, in a group of surgically resected cN0-1 but pN2 tumours, to compare the survival of patients with and without 18F-FDG avid mediastinal nodes.Retrospective review of a surgical database identified cN0-1 non-small-cell lung cancer (NSCLC) patients with pN2 disease after resection. Survival of non-FDG avid N2 versus FDG avid N2 groups was compared after stratification according to variables found on univariate analysis to affect survival.From January 1993 to December 2006, 42 patients were identified; 27 (64%) had non-FDG avid N2 disease. Five-year and median survival were better in the non-FDG avid N2 disease group, 25% versus 0% and 30 (16-44) versus 13 (10-16) months, respectively (p=0.02). After 1998, the difference in survival was 41% versus 0% and 35 (14-56) versus 12 (16-18) months, respectively (p=0.02).After resection, patients with non-FDG avid N2 disease have better survival than patients with FDG avid N2 disease. Exploratory thoracotomy alone (after frozen section analysis) cannot be advocated in patients with non-FDG avid N2 disease as survival after resection appears at least equivalent to alternate therapeutic approaches in this group. This assertion may be tempered if right pneumonectomy is required or R0 resection is unachievable. Mediastinal nodal avidity may improve stratification in future studies of long-term survival in NSCLC.
Gov't Doc #: 20580245
DOI: 10.1016/j.ejcts.2010.04.040
Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Type: Journal Article
Subjects: Aged
Carcinoma, Non-Small-Cell Lung.pathology.radionuclide
Epidemiologic Methods
Fluorodeoxyglucose F18.diagnostic use
Lung Neoplasms.pathology.radionuclide
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Positron-Emission Tomography.methods
Postoperative Complications
Radiopharmaceuticals.diagnostic use
Treatment Outcome
Appears in Collections:Journal articles

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