Impact of preoperative 18F-FDG PET/CT on survival of resected mono-metastatic non-small cell lung cancer

Simone Tönnies; Mario Tönnies; Jens Kollmeier; Torsten T Bauer; Gregor J Förster; Dirk Kaiser; Klaus-Dieter Wernecke; Joachim Pfannschmidt

doi:10.1016/j.lungcan.2015.12.008

Impact of preoperative 18F-FDG PET/CT on survival of resected mono-metastatic non-small cell lung cancer

Lung Cancer. 2016 Mar:93:28-34. doi: 10.1016/j.lungcan.2015.12.008. Epub 2015 Dec 30.

Authors

Simone Tönnies¹, Mario Tönnies¹, Jens Kollmeier², Torsten T Bauer², Gregor J Förster³, Dirk Kaiser¹, Klaus-Dieter Wernecke⁴, Joachim Pfannschmidt⁵

Affiliations

¹ Department of Thoracic Surgery, Heckeshorn Lung Clinic, Berlin, Germany.
² Department of Pneumology, Heckeshorn Lung Clinic, Berlin, Germany.
³ Department of Nuclear Medicine, HELIOS Klinikum Emil von Behring, Germany.
⁴ Sophisticated Statistical Analyses-SOSTANA, Berlin, Germany.
⁵ Department of Thoracic Surgery, Heckeshorn Lung Clinic, Berlin, Germany. Electronic address: joachim.pfannschmidt@helios-kliniken.de.

PMID: 26898611
DOI: 10.1016/j.lungcan.2015.12.008

Abstract

Objectives: Surgery has been available for the treatment of mono-metastatic, non-small cell lung cancer (NSCLC) and promising overall survival was observed in some retrospective studies with selected patients. This study investigated whether the preoperative 18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) scan influences survival in this patient group. Furthermore we tried to identify other prognostic factors associated with survival and aimed to clarify if synchronous metastases are different from metachronous disease.

Methods: Between 1994 and 2012, 181 patients underwent resection for solitary metastases. Sixty-six patients underwent surgery after an initial FDG-PET/CT scan, whereas 115 patients underwent conventional preoperative staging by a spiral CT scan.

Results: The overall 5-year survival rate was 38.8%. The 5-year survival rates after preoperative evaluation by FDG-PET/CT and by conventional CT were 58% and 33%, respectively (p=0.01). A higher 5-year survival rate was observed in patients without thoracic lymph node involvement (pN0: 44% vs. pN1-3: 33%, p=0.028). In patients with a solitary pulmonary metastasis, we observed a 5-year survival rate of 45.7%, whereas in patients with extrapulmonary metastases, the 5-year survival rate was 27.1% (p=0.001). In patients with a locally limited primary lung cancer according to the pT descriptor, we observed a 5-year survival rate of 53.1%, whereas in patients with a pT>1 descriptor, the 5-year survival rate was 33.6% (p=0.016). By multivariate analyses, we showed that preoperative FDG-PET/CT evaluation, no thoracic lymph node metastases, and sole pulmonary metastatic disease were favorable predictors of survival, whereas the time of metastasis (synchronous vs. metachronous) and maximum standardized uptake value was not.

Conclusions: We conclude that resection of the primary tumor and metastasectomy for mono-metastatic NSCLC can be performed after a comprehensive evaluation with FDG-PET/CT. N-stage and the site of the oligometastases have a significant influence on overall survival.

Keywords: Metastasectomy; Non-small cell lung cancer; Oligometastases; PET/CT; Survival rate.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / diagnosis*
Carcinoma, Non-Small-Cell Lung / mortality*
Carcinoma, Non-Small-Cell Lung / secondary
Carcinoma, Non-Small-Cell Lung / surgery
Female
Fluorodeoxyglucose F18*
Humans
Lung Neoplasms / diagnosis*
Lung Neoplasms / mortality*
Lung Neoplasms / secondary
Lung Neoplasms / surgery
Male
Middle Aged
Positron-Emission Tomography*
Preoperative Care
Prognosis
Survival Analysis
Tomography, X-Ray Computed*
Tumor Burden

Substances

Fluorodeoxyglucose F18