The clinicopathological features associated with skip N2 metastases in patients with clinical stage IA non-small-cell lung cancer
Autor: | Munetaka Masuda, Hirofumi Uehara, Hiroaki Kuroda, Ken Nakagawa, Yukinori Sakao, Sakae Okumura, Yuichi Ishikawa, Atsuo Gorai, Mingyon Mun |
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Rok vydání: | 2014 |
Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms Lymphovascular invasion medicine.medical_treatment Gastroenterology Carcinoembryonic antigen Carcinoma Non-Small-Cell Lung Internal medicine medicine Humans Stage (cooking) Lung cancer Aged Neoplasm Staging Retrospective Studies Aged 80 and over biology business.industry Mediastinum General Medicine Middle Aged medicine.disease Surgery Dissection ROC Curve Lymphatic Metastasis Mediastinal lymph node biology.protein Adenocarcinoma Female Lymphadenectomy Lymph Nodes Cardiology and Cardiovascular Medicine business |
Zdroj: | European Journal of Cardio-Thoracic Surgery. 47:653-658 |
ISSN: | 1873-734X 1010-7940 |
Popis: | OBJECTIVES: Understanding the clinicopathological features of patients with skip N2 metastases (SN2) in clinical early stage lung cancer is important for surgical planning and other treatment considerations; however, the factors associated with SN2 are unclear. This study aimed to investigate the clinicopathological features associated with SN2 in patients with clinical stage IA (cIA) non-small-cell lung cancer (NSCLC). METHODS: We retrospectively studied patients with cIA NSCLC who underwent pulmonary resection (at least lobectomy) and extensive lymphadenectomy (more than ND2a-1) at our institution between January 2004 and December 2010. We investigated the following factors for their association with SN2: age; sex; tumour marker (carcinoembryonic antigen); tumour size on computed tomography (CT), evaluated with a lung-window (LW) and a mediastinal-window (MW) setting; pathology, with or without adenocarcinoma; differentiation; visceral pleural invasion (VPI) and vascular/lymphatic invasion. RESULTS: In total, 422 patients were enrolled, with the following pathological node (pN) statuses: 331 pN0 (78.4%), 39 pN1 (9.3%) and 52 pN2 (12.3%). There were 21 (23.1%) SN2 cases among the patients with nodal metastases. When the cut-off level was defined as a receiver operating characteristic curve with MW (11.5 mm), the sensitivity and specificity of SN2 was 95.2% and 42.9%, respectively. VPI was a statistically independent relevant factor for SN2 in both the patients with cIA and in those with nodal involvement. The VPI classification comprised 59 PL-0 (64.8%), 12 PL-1 (13.2%) and 20 PL-2 (22.0%) with nodal metastases, and there was a significant difference between the three groups (P= 0.03) according to SN2 frequency. There was no difference between VPI 1 and 2 (P= 0.27). CONCLUSIONS: In conclusion, our study suggests that the incidence of SN2 is significantly associated with VPI in patients with cIA NSCLC. Although MW (>11.5 mm) had a low specificity in the assessment of SN2, it had a high sensitivity, suggesting the possibility of a superior benefit compared with LW. Standard hilar and mediastinal lymph node dissection should be required in patients with suspicious VPI and MW (>11.5 mm) on preoperative CT. |
Databáze: | OpenAIRE |
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