Clinical Predictors of Persistent Mediastinal Nodal Disease After Induction Therapy for Stage IIIA N2 Non-Small Cell Lung Cancer

Abstract

Patients with upper lobe tumors and less than 60% reduction in N2 SUVmax are more likely to have persistent N2 disease, which is often associated with poor survival rates. These clinical prognostic criteria may help surgeons in stratifying patients and properly selecting optimal surgical candidates.

Predictive and Prognostic Role of Metabolic Response in Patients With Stage III NSCLC Treated With Neoadjuvant Chemotherapy

“…This cutoff value is comparable to 60% of SUVmax found in previous studies. 15,16 However, along with DSUVmax, we also identified other metabolic parameters significantly different between the 2 groups, namely post-SUVmax, post-SUVmean, post-TLG, DSUVmean, DMTV, and DTLG.…”

“…[29][30][31][32][33] Additionally, we also showed that lymph node uptakes in patients post-treatment, expressed both as absolute values and percentage changes, were significantly different between the 2 groups (responders vs. non-responders). Although most studies in the literature have evaluated the metabolic activity of regional lymph nodes as a prognostic index, Kamel et al 15 showed that less than Metabolic Response in NSCLC After Neoadjuvant Therapy 60% reduction in N2 SUVmax after induction therapy was an independent predictor of residual N2 disease, which is often associated with poor survival outcomes. In our population, we found the cutoff value of 55.7% in DSUVmax from lymph nodes well differentiated between responders and non-responders with a sensitivity of 83%.…”

“…14 Similarly, only few studies have investigated metabolic response in involved regional lymph nodes as prognostic factors, most of which based essentially on maximum standardized uptake value (SUVmax) changes. 15,16 The purpose of this study was to evaluate the role of 18F-FDG PET/CT parameters in assessing response to neoadjuvant chemotherapy, both within the primary tumor and regional lymph nodes, and predicting prognosis of patients with stage III NSCLC in the neoadjuvant setting.…”

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

“…The study by Kamel et al proposed the use of PET scan as a tool to determine the down staging of mediastinal nodal disease (27). Although as stated earlier, PET suffers from a lack of sensitivity to detect mediastinal nodal disease, the authors suggest in their study that PET can guide the surgeon as to the operability of the patient after induction therapy.…”

PACIFIC: Time for a surgical IIIA uprising

“…Certainly, the role of preinduction and postinduction positron emission tomography (PET)-computed tomography (CT) standardized uptake value (SUV) has been controversial with recent reports stating that the presence of residual nodal disease is not predicted by PET-CT, 8 whereas other studies report that less than 60% reduction in N2 SUVmax is more likely to reflect persistent N2 disease. 10 The International Association for the Study of Lung Cancer has recently emphasized capturing prospective data not only on the site and number of N2 stations involved, but also the influence of concomitant N1 and N2 disease. 11 Other novel approaches for quantification of N2 disease and prognosis include measurement of CT lymph node volume but might not predict posttreatment response.…”