title: Impact of preoperative 18F-FDG PET/CT on survival of resected mono-metastatic non-small cell lung cancer.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Thoracic Surgery, Heckeshorn Lung Clinic, Berlin, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Tönnies
authors.affiliation: Department of Thoracic Surgery, Heckeshorn Lung Clinic, Berlin, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Tönnies
authors.affiliation: Department of Pneumology, Heckeshorn Lung Clinic, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kollmeier
authors.affiliation: Department of Pneumology, Heckeshorn Lung Clinic, Berlin, Germany.
authors.forename: Torsten T
authors.initials: TT
authors.lastname: Bauer
authors.affiliation: Department of Nuclear Medicine, HELIOS Klinikum Emil von Behring, Germany.
authors.forename: Gregor J
authors.initials: GJ
authors.lastname: Förster
authors.affiliation: Department of Thoracic Surgery, Heckeshorn Lung Clinic, Berlin, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Kaiser
authors.affiliation: Sophisticated Statistical Analyses-SOSTANA, Berlin, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Department of Thoracic Surgery, Heckeshorn Lung Clinic, Berlin, Germany. Electronic address: joachim.pfannschmidt@helios-kliniken.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Pfannschmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011379:Prognosis; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Metastasectomy; Non-small cell lung cancer; Oligometastases; PET/CT; Survival rate