P199. Utilization of Invasive Mediastinal Nodal Staging and Incidence of Occult Nodal Disease in Synchronous Primary Lung Cancer
Presented During: Thoracic Poster Session II
Memorial Sloan Kettering Cancer Center
New York, NY
United States - Contact Me
Nanruoyi "Zoe" Zhou is a general surgery resident at NewYork Presbyterian Weill Cornell Medical Center who is currently pursuing a two-year research fellowship at Memorial Sloan Kettering Cancer Center under the mentorship of Dr. David Jones.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
Objective: Current guidelines recommend invasive mediastinal nodal staging (IMNS) in patients with synchronous primary lung cancer (SPLC) being considered for curative resection. The goal of this study was to investigate the utilization rate of IMNS and incidence of occult nodal disease in SPLC.
Methods: Patients with SPLC identified on pre-operative imaging and surgically resected from January 2000 to September 2022 were identified from a single center prospectively maintained database. Exclusion criteria included recurrent and metachronous lung cancer, metastatic disease, carcinoid-only histology, lack of pre-operative PET/CT, and neoadjuvant therapy. Pearson's Chi-squared test and Fisher's exact test were used to compare categorical variables. The Wilcoxon rank sum test was used to compare continuous variables.
Results: 676/11,403 patients had SPLC and underwent resection during the study period. Of these, 25% (167/676) underwent invasive mediastinal nodal staging (IMNS) via endobronchial ultrasound (EBUS, N=91), mediastinoscopy (N=73), or both (N=3) with a median of 3 lymph node stations sampled. 11 patients had positive N1 nodes and 36 patients had positive N2 nodes after IMNS. 132 patients underwent neoadjuvant therapy. Only 544 patients who underwent up-front surgery were included in subsequent analyses. Of these, 18% (100/544) underwent IMNS. Patients who underwent IMNS had higher Tstage, increased SUVmax and involvement of bilateral lungs (all p<0.001). Of the 35 patients who were cN0 by PET/CT and underwent EBUS, no patients had N2 disease and one patient had N1 disease discovered after EBUS. No cN0/cN1 patients had positive N2 nodes after IMNS but 12% (10/82) had occult pN2 disease post-resection. Overall, 14% (71/521) of cN0 patients had occult nodal disease after surgery, with 6% (31/521) having pN2 disease.
Conclusions: Selective use of IMNS in staging of cN0/N1 SPLC results in acceptably low pN2 rates. Selection of patients with SPLC for IMNS should be individualized based on Tstage, increased SUVmax, and synchronous bilateral lesions.
Authors
Nanruoyi Zhou (1), Stella Tsui (1), Nicolas Toumbacaris (1), Kay See Tan (1), Joe Dycoco (1), Alexis Chidi (1), Katherine Gray (1), Smita Sihag (1), Bernard Park (1), Matthew Bott (1), Prasad Adusumilli (1), Daniela Molena (1), Valerie Rusch (1), James Huang (1), Manjit Bains (1), Gaetano Rocco (1), James Isbell (1), David Jones (1)
Institutions
(1) Memorial Sloan Kettering Cancer Center, New York, NY
Methods: Patients with SPLC identified on pre-operative imaging and surgically resected from January 2000 to September 2022 were identified from a single center prospectively maintained database. Exclusion criteria included recurrent and metachronous lung cancer, metastatic disease, carcinoid-only histology, lack of pre-operative PET/CT, and neoadjuvant therapy. Pearson's Chi-squared test and Fisher's exact test were used to compare categorical variables. The Wilcoxon rank sum test was used to compare continuous variables.
Results: 676/11,403 patients had SPLC and underwent resection during the study period. Of these, 25% (167/676) underwent invasive mediastinal nodal staging (IMNS) via endobronchial ultrasound (EBUS, N=91), mediastinoscopy (N=73), or both (N=3) with a median of 3 lymph node stations sampled. 11 patients had positive N1 nodes and 36 patients had positive N2 nodes after IMNS. 132 patients underwent neoadjuvant therapy. Only 544 patients who underwent up-front surgery were included in subsequent analyses. Of these, 18% (100/544) underwent IMNS. Patients who underwent IMNS had higher Tstage, increased SUVmax and involvement of bilateral lungs (all p<0.001). Of the 35 patients who were cN0 by PET/CT and underwent EBUS, no patients had N2 disease and one patient had N1 disease discovered after EBUS. No cN0/cN1 patients had positive N2 nodes after IMNS but 12% (10/82) had occult pN2 disease post-resection. Overall, 14% (71/521) of cN0 patients had occult nodal disease after surgery, with 6% (31/521) having pN2 disease.
Conclusions: Selective use of IMNS in staging of cN0/N1 SPLC results in acceptably low pN2 rates. Selection of patients with SPLC for IMNS should be individualized based on Tstage, increased SUVmax, and synchronous bilateral lesions.
Authors
Nanruoyi Zhou (1), Stella Tsui (1), Nicolas Toumbacaris (1), Kay See Tan (1), Joe Dycoco (1), Alexis Chidi (1), Katherine Gray (1), Smita Sihag (1), Bernard Park (1), Matthew Bott (1), Prasad Adusumilli (1), Daniela Molena (1), Valerie Rusch (1), James Huang (1), Manjit Bains (1), Gaetano Rocco (1), James Isbell (1), David Jones (1)
Institutions
(1) Memorial Sloan Kettering Cancer Center, New York, NY