Which definition of a central tumour is more predictive of occult mediastinal metastasis in nonsmall cell lung cancer patients with radiological N0 disease?
Which definition of a central tumour is more predictive of occult mediastinal metastasis in nonsmall cell lung cancer patients with radiological N0 disease?
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DOI：
10.1183/13993003.01508-2018
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发表时间：
2019-03-01
影响因子：
24.3
通讯作者：
Jeong, Byeong-Ho
中科院分区：
文献类型：
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作者：
Shin, Sun Hye;Jeong, Dong Young;Jeong, Byeong-Ho
背景资料：指南建议对位于中心的肿瘤进行侵袭性纵隔分期，即使是放射学N 0非小细胞肺癌（NSCLC）。然而，有没有一个中央肿瘤，是更隐匿性纵隔transfermental.Methods预测统一的定义：共1337例连续的放射学N 0疾病进行侵入性纵隔分期。肿瘤被分为中央和外周7个不同definition.Results：约7%（93 1337）的患者有隐匿性N2疾病，他们有显着较大的肿瘤大小和更多的实体瘤的计算机断层扫描。在调整患者和肿瘤相关特征后，只有通过从中线绘制同心线所采用的半侧胸廓内三分之一的中心肿瘤定义显著预测了隐匿性N2疾病（调整后OR 2.13，95%CI 1.17-3.87; p=0.013）。在排除了纯磨玻璃样结节的患者后，（校正OR 2.54，95% CI 1.37-4.71; p=0.003）或仅包括实体瘤患者（调整后OR 2.30，95% CI 1.08-4.88; p=0.030）。我们建议，中央肿瘤应确定使用内三分之一的半胸通过画同心线从中线。这对于预测非小细胞肺癌患者的隐性N2疾病特别有用。
Background: Guidelines recommend invasive mediastinal staging for centrally located tumours, even in radiological N0 nonsmall cell lung cancer (NSCLC). However, there is no uniform definition of a central tumour that is more predictive of occult mediastinal metastasis.Methods: A total of 1337 consecutive patients with radiological N0 disease underwent invasive mediastinal staging. Tumours were categorised into central and peripheral by seven different definitions.Results: About 7% (93 out of 1337) of patients had occult N2 disease, and they had significantly larger tumour size and more solid tumours on computed tomography. After adjustment for patient-and tumour-related characteristics, only the central tumour definition of the inner one-third of the hemithorax adopted by drawing concentric lines arising from the midline significantly predicted occult N2 disease (adjusted OR 2.13, 95% CI 1.17-3.87; p=0.013). This association was maintained after excluding patients with pure ground-glass nodules (adjusted OR 2.54, 95% CI 1.37-4.71; p=0.003) or only including those with solid tumours (adjusted OR 2.30, 95% CI 1.08-4.88; p=0.030).Conclusions: We suggest that a central tumour should be defined using the inner one-third of the hemithorax adopted by drawing concentric lines from the midline. This is particularly useful for predicting occult N2 disease in patients with NSCLC.