The Clinical Stage of Non-Small Cell Lung Cancer as Assessed by FDG-PET/CT Scan is Less Accurate in Smokers
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OBJECTIVE: The treatment of non-small cell lung cancer depends on the stage and this is clinically best determined by FDG-PET/CT. We evaluated the effect smoking has on the accuracy of this test.
METHODS: A prospective cohort study evaluating the accuracy of clinical stage compared to pathologic stage between smokers and non-smokers with non-small cell lung cancer. All patients were assigned a clinical TNM stage after FDG-PET/CT scan and then underwent meticulously pathologic TNM staging. If N2, N3 or M1 negative, patients underwent thoracotomy with complete thoracic lymphadenectomy. The clinical and pathologic stages were compared.
RESULTS: There were 246 patients: 52 never smoked (NS), 112 quit at least 1 month prior to FDG-PET/CT (Q), and 82 were still smokers (SS). The three groups were similar for stage and histology. The overall accuracy for the three groups were: 80%, 83% and 64% for the NS, Q and SS groups respectively (p=0.03). The accuracy for the T status was 88%, 84% and 86%, for the N2 nodes it was 96%, 75% and 72% and for the N1 nodes it was 92%, 78% and 80% favoring the NS group. The greater the pack year history the greater the N2 inaccuracy (p=0.04).
CONCLUSIONS: Patients with non-small cell lung cancer who continue to smoke at the time of their FDG-PET/CT scan have less accurate clinical staging compared to those who stopped 1 month prior or who never smoked. As the pack years increase the accuracy for the N2 nodes decrease. Non-smokers have the most accurate clinical staging.
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