Staging of Early-Stage Lung Cancer without Routine PET in Candidates for Segmentectomy

Area of Science:

• Thoracic Surgery
• Oncology
• Radiology

Background:

• Accurate clinical staging is crucial for non-small cell lung cancer (NSCLC) treatment planning.
• Positron emission tomography/computed tomography (PET/CT) is often used for staging, but its routine necessity is debated.

Purpose of the Study:

• To assess the accuracy of clinical staging without routine PET/CT in patients with clinical stage I NSCLC (cIA1 and cIA2) undergoing segmentectomy.
• To identify factors associated with pathologic upstaging in this patient cohort.

Main Methods:

• Retrospective analysis of 305 segmentectomies.
• Kaplan-Meier method for overall survival calculation.
• Logistic regression to identify predictors of pathologic upstaging.

Main Results:

• 28% of patients experienced pathologic upstaging (UICC).
• Upstaged patients had longer operative times, more lymph node resections, and higher rates of L1 involvement.
• L1 involvement and number of dissected lymph nodes were independent predictors of upstaging.
• No significant reduction in nodal upstaging was observed in patients who received PET as part of clinical staging.

Conclusions:

• Clinical staging accuracy without routine PET/CT is a concern for early-stage NSCLC.
• Selective use of PET/CT, guided by CT findings, may be a cost-effective strategy for NSCLC patients with tumors up to 2cm.