title: Non-small cell lung cancer: prognostic importance of positive FDG PET findings in the mediastinum for patients with N0-N1 disease at pathologic analysis.
abstract: OBJECTIVE
  To assess the prognostic implications of mediastinal positron emission tomographic (PET) findings in patients undergoing curative resection of non-small cell lung cancer (NSCLC) who have histologically negative mediastinal lymph nodes (LNs), with the hypothesis that positive findings at PET are prognostic even in patients with negative histologic findings in the LNs.
  
  
  METHODS
  Records of patients with a preoperative PET undergoing curative surgery, without adjuvant radiation, for pathologic T1-3N0-1 NSCLC at the University of North Carolina between 2000 and 2006 were reviewed as an institutional review board-approved HIPAA-compliant retrospective study. Ninety patients were evaluable (all histologically negative in mediastinum; 44 with both mediastinoscopy and surgery); 13 patients had positive mediastinal PET findings, and 77 had negative mediastinal PET findings. Local-regional and distant failure rates in patients with and those without mediastinal abnormalities at preoperative PET were compared by using logistic regression and log-rank tests.
  
  
  RESULTS
  Median follow-up was 54.3 months (range, 1-99 months). There were higher rates of local-regional (P = .001) and distant (P < .001) failure as well as death (P = .001) in patients with postive PET findings than in patients with negative findings. In multivariable analysis (adjusting for other prognostic factors), positive PET findings in the mediastinum remained prognostic for distant failure (P < .001, hazard ratio = 6.9) and were marginally prognostic for local-regional failure (P = .093, hazard ratio = 1.9).
  
  
  CONCLUSIONS
  Positive findings at preoperative PET in the mediastinum appear to have prognostic implications despite the mediastinal LNs being histologically negative. The high rate of local-regional and distant failure suggests that postoperative radiation therapy and/or chemotherapy may be particularly helpful in patients with positive mediastinal findings at preoperative PET.
authors.affiliation: Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA.
authors.forename: Liyi
authors.initials: L
authors.lastname: Xie
authors.forename: Mert
authors.initials: M
authors.lastname: Saynak
authors.forename: Nirmal K
authors.initials: NK
authors.lastname: Veeramachaneni
authors.forename: David V
authors.initials: DV
authors.lastname: Fried
authors.forename: Mandar R
authors.initials: MR
authors.lastname: Jagtap
authors.forename: Wing Keung
authors.initials: WK
authors.lastname: Chiu
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Higginson
authors.forename: Michael V
authors.initials: MV
authors.lastname: Lawrence
authors.forename: Amir H
authors.initials: AH
authors.lastname: Khandani
authors.forename: Bahjat F
authors.initials: BF
authors.lastname: Qaqish
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18