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Cao W, Tang Q, Zeng J, Jin X, Zu L, Xu S. A Review of Biomarkers and Their Clinical Impact in Resected Early-Stage Non-Small-Cell Lung Cancer. Cancers (Basel) 2023; 15:4561. [PMID: 37760531 PMCID: PMC10526902 DOI: 10.3390/cancers15184561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The postoperative survival of early-stage non-small-cell lung cancer (NSCLC) patients remains unsatisfactory. In this review, we examined the relevant literature to ascertain the prognostic effect of related indicators on early-stage NSCLC. The prognostic effects of the epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), mesenchymal-epithelial transition (MET), C-ros oncogene 1 (ROS1), or tumour protein p53 (TP53) alterations in resected NSCLC remains debatable. Kirsten rat sarcoma viral oncogene homologue (KRAS) alterations indicate unfavourable outcomes in early-stage NSCLC. Meanwhile, adjuvant or neoadjuvant EGFR-targeted agents can substantially improve prognosis in early-stage NSCLC with EGFR alterations. Based on the summary of current studies, resected NSCLC patients with overexpression of programmed death-ligand 1 (PD-L1) had worsening survival. Conversely, PD-L1 or PD-1 inhibitors can substantially improve patient survival. Considering blood biomarkers, perioperative peripheral venous circulating tumour cells (CTCs) and pulmonary venous CTCs predicted unfavourable prognoses and led to distant metastases. Similarly, patients with detectable perioperative circulating tumour DNA (ctDNA) also had reduced survival. Moreover, patients with perioperatively elevated carcinoembryonic antigen (CEA) in the circulation predicted significantly worse survival outcomes. In the future, we will incorporate mutated genes, immune checkpoints, and blood-based biomarkers by applying artificial intelligence (AI) to construct prognostic models that predict patient survival accurately and guide individualised treatment.
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Affiliation(s)
- Weibo Cao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; (W.C.); (Q.T.); (J.Z.); (X.J.); (L.Z.)
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Quanying Tang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; (W.C.); (Q.T.); (J.Z.); (X.J.); (L.Z.)
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jingtong Zeng
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; (W.C.); (Q.T.); (J.Z.); (X.J.); (L.Z.)
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Jin
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; (W.C.); (Q.T.); (J.Z.); (X.J.); (L.Z.)
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lingling Zu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; (W.C.); (Q.T.); (J.Z.); (X.J.); (L.Z.)
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China; (W.C.); (Q.T.); (J.Z.); (X.J.); (L.Z.)
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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Li F, Lv Q, Wang Y, Zhao S, Guo T, Wang G, Gu C. Prognostic Value of Pretreatment Serum Carcinoembryonic Antigen Level in 1130 Patients With Non-small Cell Lung Cancer: A Propensity Score Matching Cohort Study and Cumulative Meta-analysis. Am J Clin Oncol 2023; 46:399-408. [PMID: 37390106 DOI: 10.1097/coc.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Carcinoembryonic antigen (CEA) is the most frequently used tumor marker for non-small cell lung cancer (NSCLC). The current study aimed to provide the highest-level evidence of the prognostic value of pretreatment serum CEA level for NSCLC through the appropriate statistical methodology and large-sample cohorts. METHODS The current retrospective cohort study with 1130 patients with NSCLC treated by thoracic surgery with pretreatment serum CEA concentrations above/below 5 ng/mL. Propensity score matching, Kaplan-Miere survival analysis, and Cox proportional hazard regression models were used to study the intergroup variance. The overall/disease-free hazard ratios (HRs) of the current study were combined with the previously published studies using cumulative meta-analysis to provide the highest-level evidence. RESULTS Intergroup confounding variables were well controlled by propensity score matching, and the survival differences were statistically significant. The Cox univariate analysis showed that the overall and disease-free HRs of the high CEA towards patients with low CEA were 1.595 (95% CI: 1.329-1.863, P = 0.004) and 1.498 (95% CI: 1.271-1.881, P = 0.004). The HRs of multivariate analysis were adjusted to 1.586 (95% CI: 1.398-1.812, P = 0.016) and 1.413 (95% CI: 1.22-1.734, P = 0.022) respectively. The cumulative meta-analysis showed that the cumulative overall HR was in accord with previous studies, and the cumulative disease-free HR turn to be statistically significant. CONCLUSIONS Pretreatment serum CEA level was an independent influence factor of overall/disease-free survival of patients with NSCLC, and even for patients with the same pTNM stages or pathologic stages, it is used for prognosis.
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Affiliation(s)
- Fengzhou Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- Lung Cancer Diagnosis and Treatment Center, Dalian, Liaoning, People's Republic of China
| | - Qing Lv
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- Graduate school, Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Yufei Wang
- Institute of Neurology, General Hospital of Shenyang Military Command, Shenyang, Liaoning, People's Republic of China
| | - Shilei Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- Lung Cancer Diagnosis and Treatment Center, Dalian, Liaoning, People's Republic of China
| | - Tao Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- Lung Cancer Diagnosis and Treatment Center, Dalian, Liaoning, People's Republic of China
| | - Gang Wang
- Graduate school, Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Chundong Gu
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
- Lung Cancer Diagnosis and Treatment Center, Dalian, Liaoning, People's Republic of China
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History, molecular features, and clinical importance of conventional serum biomarkers in lung cancer. Surg Today 2017; 47:1037-1059. [DOI: 10.1007/s00595-017-1477-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/04/2017] [Indexed: 01/27/2023]
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Xu Y, Sun H, Zhang Z, Song A, Wang W, Lu X. Assessment of Relationship Between CT Features and Serum Tumor Marker Index in Early-stage Lung Adenocarcinoma. Acad Radiol 2016; 23:1342-1348. [PMID: 27426977 DOI: 10.1016/j.acra.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/04/2016] [Accepted: 06/16/2016] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to assess the relationship between tumor marker index (TMI) and high-resolution computed tomography features in early-stage lung adenocarcinoma. MATERIALS AND METHODS Seventy-four stage IA lung adenocarcinomas confirmed pathologically were retrospectively evaluated. Lung nodules were divided into two types: solid nodule (SN) and subsolid nodule (SSN). The maximum diameters on mediastinal window in axial imaging (Dm) and tumor shadow disappearance rate (TDR) were measured. Meanwhile, other computed tomography features of lung nodules were also recorded. TMI represents the geometric mean of normalized CEA and CYFRA 21-1 values, and the discriminatory value of TMI in this study was set at 1.0. The evaluation of discriminatory values for Dm and the TMI between SNs and SSNs was done with Mann-Whitney U-test. The relationship between TDR and TMI in SSNs was evaluated by Pearson correlation analysis. RESULTS Of 74 cases, 40 cases (54.05%) showed SNs and 34 cases (45.95%) showed SSNs. Dm and TMI were higher in SNs than in SSNs (z = -4.782, P < 0.001; z = -2.647, P = 0.008). TDR demonstrated negative relationship with TMI in SSNs (r = -0.448, P = 0.008). Spiculation (odds ratio [OR] = 14.685; 95% confidence interval [CI]: 2.739-78.729; P = 0.002), nodule type (OR = 6.215; 95% CI: 1.531-25.228; P = 0.011), and gender (OR = 0.227; 95% CI: 0.062-0.833; P = 0.025) were independent factors associated with TMI. CONCLUSIONS Early-stage lung adenocarcinoma with lower TDR coexisting with spiculation was associated with higher TMI, especially in patients with solid nodule, which tended to have poor prognosis.
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Kim JJ, Hyun K, Park JK, Moon SW. The Significance of Serum Carcinoembryonic Antigen in Lung Adenocarcinoma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:335-44. [PMID: 26509127 PMCID: PMC4622033 DOI: 10.5090/kjtcs.2015.48.5.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/04/2014] [Accepted: 12/05/2014] [Indexed: 01/15/2023]
Abstract
Background A raised carcinoembryonic antigen (CEA) may be associated with significant pathology during the postoperative follow-up of lung adenocarcinoma. Methods We reviewed the medical records of 305 patients who underwent surgical resections for primary lung adenocarcinoma at a single institution between April 2006 and February 2013. Results Preoperative CEA levels were significantly associated with age, smoking history, pathologic stage including pT (pathologic tumor stge), pN (pathologic nodal stage) and overall pathological stage, tumor size and differentiation, pathologically positive total lymph node, N1 and N2 lymph node, N2 nodal station (0/1/2=1.83/2.94/7.21 ng/mL, p=0.019), and 5-year disease-free survival (0.591 in group with normal preoperative CEA levels vs. 0.40 in group with high preoperative CEA levels, p=0.001). Preoperative CEA levels were significantly higher than postoperative CEA levels (p<0.001, Wilcoxon signed-rank test). Postoperative CEA level was also significantly associated with disease-free survival (p<0.001). A follow-up serum CEA value of >2.57 ng/mL was found to be the appropriate cutoff value for the prediction of cancer recurrence with sensitivity and specificity of 71.4% and 72.3%, respectively. Twenty percent of patients who had recurrence of disease had a CEA level elevated above this cutoff value prior to radiographic evidence of recurrence. Postoperative CEA, pathologic stage, differentiation, vascular invasion, and neoadjuvant therapy were identified as independent predictors of 5-year disease-free survival in a multivariate analysis. Conclusion The follow-up CEA level can be a useful tool for detecting early recurrence undetected by postoperative imaging studies. The perioperative follow-up CEA levels may be helpful for providing personalized evaluation of lung adenocarcinoma.
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Affiliation(s)
- Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Kwanyong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea College of Medicine
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Prognostic significance of preoperative serum carcinoembryonic antigen in non-small cell lung cancer: a meta-analysis. Tumour Biol 2014; 35:10105-10. [DOI: 10.1007/s13277-014-2301-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022] Open
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Yamazaki M, Ishikawa H, Kunii R, Tasaki A, Sato S, Ikeda Y, Yoshimura N, Aoyama H. Relationship between CT features and high preoperative serum carcinoembryonic antigen levels in early-stage lung adenocarcinoma. Clin Radiol 2014; 69:559-66. [DOI: 10.1016/j.crad.2013.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/05/2013] [Accepted: 12/12/2013] [Indexed: 12/17/2022]
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Prognostic significance of postoperative serum carcinoembryonic antigen levels in patients with completely resected pathological-stage I non-small cell lung cancer. J Cardiothorac Surg 2013; 8:106. [PMID: 23607757 PMCID: PMC3639185 DOI: 10.1186/1749-8090-8-106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Until date, there are no clear recommendations for regular perioperative measurements of serum CEA levels for lung cancer in any guidelines. The purpose in the present study is to evaluate the prognostic significance of perioperative serum carcinoembryonic antigen (CEA) levels in patients with pathological-stage I non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed 263 completely resected pathological-stage I NSCLC patients whose preoperative and postoperative serum CEA levels were measured. Patients were subdivided according to the perioperative change of CEA levels: continuously normal CEA levels (NN group), continuously high CEA levels (HH group), and high preoperative CEA levels that returned to normal levels post-operation (HN group). The clinicopathological factors and overall survival (OS) among these 3 groups were compared. Univariate and multivariate analyses of the correlation between clinicopathological factors and OS were performed. RESULTS High preoperative CEA levels significantly correlated with men aged >70 years with smoking history, high serum CYFRA 21-1 levels, greater tumor diameter, presence of visceral pleural invasion (VPI), and moderate-to-poor differentiation. Five-year OS rates in the NN and HH groups were 95.5% and 59.3%, respectively. Four-year OS rate in the HN group was 85.5%. Multivariate analyses indicated tumor diameter of more than 30 mm, presence of VPI, and the HH group were independent unfavorable prognostic factors. CONCLUSIONS A high postoperative CEA level was an independent unfavorable prognostic factor in pathological-stage I NSCLC patients. Patients with high postoperative CEA levels may benefit from adjuvant chemotherapy.
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Kato T, Ishikawa K, Aragaki M, Sato M, Okamoto K, Ishibashi T, Oba K, Kaji M. Optimal predictive value of preoperative serum carcinoembryonic antigen for surgical outcomes in stage I non-small cell lung cancer: Differences according to histology and smoking status. J Surg Oncol 2012. [DOI: 10.1002/jso.23293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Takahashi N, Suzuki K, Takamochi K, Oh S. Prognosis of surgically resected lung cancer with extremely high preoperative serum carcinoembryonic antigen level. Gen Thorac Cardiovasc Surg 2011; 59:699-704. [PMID: 21984138 DOI: 10.1007/s11748-011-0797-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/28/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the prognosis of resected lung cancer patients with extremely high carcinoembryonic antigen (CEA) levels. Several reports have indicated that increased preoperative serum CEA levels are associated with a dismal outcome after surgery, whereas others have reported long-term survival among patients with extremely high preoperative CEA levels. We investigated whether preoperative serum CEA levels, especially extremely high levels, were related to the prognosis of non-small-cell lung cancer (NSCLC) after surgery. METHODS From September 1996 to January 2008, a total of 649 patients underwent surgical treatment for NSCLC at Juntendo University Hospital. We conducted a retrospective review to investigate the prognostic significance of the preoperative CEA level in these patients. We also investigated the prognosis of patients with an extremely high preoperative CEA level (>30 ng/ml). RESULTS The 5-year survival rates were 78.4% and 63.0% for patients with normal and abnormal preoperative CEA levels, respectively. The survival rate was significantly worse for patients with abnormal preoperative CEA levels (P = 0.0002). In all, 28 patients had preoperative CEA levels >30 ng/ml. Although most of these patients showed a poor prognosis, 7 (25.0%) were longterm survivors (>4 years). CONCLUSION An abnormal preoperative CEA level suggests a poor prognosis for patients with NSCLC after surgery. Nevertheless, a few patients with an extremely high preoperative CEA level had long-term survival. Even if the preoperative CEA is extremely high, we perform a careful survey for distant or intrathoracic metastases and should not overlook operable cases.
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Affiliation(s)
- Nobumasa Takahashi
- Division of General Thoracic Surgery, Juntendo University School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan.
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Qiu Y, Yang H, Chen H, Ge L, Xu X, Xiong X, He J. Detection of CEA mRNA, p53 and AE1/AE3 in haematoxylin-eosin-negative lymph nodes of early-stage non-small cell lung cancer may improve veracity of N staging and indicate prognosis. Jpn J Clin Oncol 2009; 40:146-52. [PMID: 19897851 DOI: 10.1093/jjco/hyp144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Although the surgical-pathological classification can be considered the 'gold standard' of T-N staging, it could not provide satisfactory and accurate estimation of survival rates in early-stage non-small cell lung cancer (NSCLC). METHODS In our study, the expression of carcinoembryonic antigen (CEA), p53 and intracytoplasmic keratin (AE1/AE3) using haematoxylin-eosin (HE) staining negative lymph nodes (LNs) in 28 patients with early-stage NSCLC were analysed using fluorescent quantitation reverse transcription-polymerase chain reaction (FQ-PCR) and immunohistochemistry (IHC). RESULTS One hundred and ninety-three LNs were analysed. Two patients staged as I up-staged to II, and six patients staged as II up-staged to III. About 32, 19 and 36 LNs were positive, respectively, for CEA mRNA (32/193, 16.6%), p53 (19/193, 9.84%) and AE1/AE3 (36/193, 18.65%) compared with control LNs. Only FQ-PCR test for CEA mRNA could detect micrometastases in stage I NSCLC patients with N0 LNs (2/13, 15.4%). Disease-free time in patients with CEA mRNA (P = 0.000), p53 protein (P = 0.013) and AE1/AE3 (P = 0.003) positive were significantly inferior to those with micrometastases negative. Moreover, the results demonstrated that the positive LNs for CEA mRNA (P = 0.028), p53 protein (P = 0.048) and AE1/AE3 (P = 0.007) were associated with the relapse time, respectively. However, Cox proportional hazards test showed that only clinical stage was the independent risk factor of relapse, and denied the correlation between micrometastases in LNs and recurrence. CONCLUSIONS Detection of CEA mRNA, p53, AE1/AE3 in HE-negative LNs may improve veracity of N staging and predict its prognosis in patients with early-stage NSCLC. Furthermore, micrometastases in stage I may be performed by FQ-PCR more sensitive than IHC.
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Affiliation(s)
- Yuan Qiu
- Department of Cardiothoracic Surgery, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
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Demir A, Turna A, Kocaturk C, Gunluoglu MZ, Aydogmus U, Urer N, Bedirhan MA, Gurses A, Dincer SI. Prognostic significance of surgical-pathologic N1 lymph node involvement in non-small cell lung cancer. Ann Thorac Surg 2009; 87:1014-22. [PMID: 19324121 DOI: 10.1016/j.athoracsur.2008.12.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 12/06/2008] [Accepted: 12/12/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with N1 non-small cell lung cancer represent a heterogeneous population with varying long-term survival. To better define the importance of N1 disease and its subgroups in non-small cell lung cancer staging, we analyzed patients with N1 disease using the sixth edition and proposed seventh edition TNM classifications. METHODS From January 1995 to November 2006, 540 patients with N1 non-small cell lung cancer who had at least lobectomy with systematic mediastinal lymphadenectomy were analyzed retrospectively. RESULTS For completely resected patients, the median survival rate and 5-year survival rate were 63 months and 50.3%, respectively. The 5-year survival rates for patients with hilar N1 (station 10), interlobar (station 11), and peripheral N1 (stations 12 to 14) involvement were 39%, 51%, and 53%, respectively. Patients with hilar lymph node metastasis showed a shorter survival period than patients with peripheral lymph node involvement (p = 0.02). Patients with hilar zone N1 (stations 10 and 11) involvement tended to show poorer survival than patients with peripheral zone N1 (12 to 14) metastasis (p = 0.08). Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (5-year survival 39% versus 51%, respectively, p = 0.01). Patients with multiple-zone N1 involvement showed poorer survival than patients with single-zone N1 metastasis (p = 0.04). A significant survival difference was observed between N1 patients with T1a versus T1b tumors (p = 0.02). Multivariate analysis revealed that only multiple-station lymph node metastasis was predictive of poor prognosis (p = 0.05). CONCLUSIONS Multiple-station versus single-station N1 disease and multiple-zone versus single-zone N1 involvement indicate poorer survival rate. Patients with hilar lymph node involvement had lower survival rates than patients with peripheral N1. The impact of T factor seemed to be veiled by the heterogenous nature of N1 disease. Further studies of adjusted postoperative strategies for different N1 subgroups are warranted.
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Affiliation(s)
- Adalet Demir
- Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
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