Predictive factors of lymph node metastasis in clinical T1aN0M0 non-small cell lung cancer
| Autor: | Chao-Yu Liu, 劉昭宇 |
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| Rok vydání: | 2018 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 106 Introduction Lung cancer with small tumor size is now frequently being detected because of the prevalent use of computed tomography (CT) as a screening tool for pulmonary lesions. Sublobar resections (wedge resection/ segmentectomy) for small non-small cell lung cancer (NSCLC) have been reported to be non-inferior to lobectomy with regard to the surgical outcomes. However, a small group of cT1N0M0 NSCLCs tend to have a worse prognosis than expected, and nodal upstaging after surgery is the main reason. Prediction of pathologic nodal upstaging is important. In our study, we aimed to reappraise the predictive factors of lymph node metastases in cT1aN0M0 (AJCC 7th edition for lung cancer) NSCLC. Methods Cases of cT1aN0M0 NSCLC after surgical resections in the National Taiwan University Hospital from 2011 to 2015 were retrospectively reviewed. The predictive factors of interest were tumor size, tumor ground glass opacity (GGO) percentage on chest CT, and preoperative serum carcinoembryonic antigen (CEA) level. Logistic regression model was used to find predictive factors for nodal upstaging. Results A total of 770 patients were included in the study. Of these, 14 (1.8%) were found to have pN+ (nodal upstaging) after pulmonary resection. Larger tumor size, less tumor GGO percentage on chest CT, and higher preoperative serum CEA levels were significant predictors for nodal upstaging. On a pathological viewpoint, decreased lepidic component of the tumor, presence of visceral pleural invasion, and presence of lymphovascular invasion were also significantly correlated with nodal upstaging. With preoperative variables grouped into categorical data, tumor size ≥ 1.5 cm, CEA ≥ 3 ng/mL, and GGO < 25% had strong predictive values for lymph node metastases. Conclusion For NSCLC patients with clinical stage T1aN0M0, tumor size, preoperative serum CEA levels, and GGO percentage on CT scan were significant predictive factors for lymph node metastases after surgery. For patients with tumor size less than 1.5 cm, serum CEA levels less than 3 ng/mL, and GGO predominant tumors, avoiding lymph node dissection can be a reasonable approach. Sublobar resection, instead of standard lobectomy, may be a good alternative for this group of patients. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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