Lung Cancer Metastases to Lymph Nodes at Celiac Axis is Common and EUS-FNA plays a Critical role for Detection of the Metastases

Background: Esophageal cancer metastases to lymph node at celiac axis (CLN) are associated with poor survival. Aim: To determine: 1) incidence of metastases to CLN in lung cancer; 2) sensitivity of the EUS-FNA and CT scan for the detection of the metastases to CLN; and, 3) the prognostic significance of metastases to CLN. Methods: Data from an ongoing prospective study at our institution were used. Consecutive subjects with newly diagnosed lung cancer underwent EUS examination and EUS-FNA of CLN was performed whenever nodes of any size could be identified. Results: Of 113 cases with lung cancer, metastases to the CLN were detected in 12 cases. The sensitivity of EUS-FNA for the detection of the metastases to the CLN was significantly higher than the CT scan (100% vs. 50%; p=0.03). Univariable analysis showed metastases to mediastinum, liver, adrenal gland and CLN, staging, curative surgery, and chemotherapy as significant predictors of survival. The median survival time in subjects with and without EUS-evidence of metastases to CLN was 142.5 days (95% CI 94,263) and 330 days (95% CI 283, 421). The difference was statistically significant (p=0.002). Cox-PH model showed metastasis to celiac axis and liver as independent predictor of poor survival (p=0.02). Conclusion: Lung cancer metastases to CLN are common (11%) and are an independent predictor of poor survival. The sensitivity of the EUS-FNA for the detection of the metastases to CLN is superior to the CT scan. We recommend EUS evaluation of the celiac axis for the complete and accurate staging of lung cancer.