A contribution on the prognostic significance of the tumor formula (pTNM) in squamous cell carcinoma of the bronchus

Prognostic value and therapeutic consequences of vascular invasion in non-small cell lung carcinoma

The prognostic relevance of blood vessel invasion (BVI) in non-small cell lung carcinoma (NSCLC) remains controversial, as is the question of whether its finding should influence therapeutic decisions after an R0 resection. One hundred and twelve cases of NSCLC were included in the study. All had been treated by potentially curative surgical resection of the primary tumor and systematic lymphadenectomy. In all cases, lymphatic metastatic spread was at its earliest stage and only one regional lymph node was involved, 27.0+/-8.9 nodes per patient being examined histologically. Most of the cases were pT2 (75.9%) and pN1 (81.3%), and all were MX/M0 and R0. 62.5% were at stage IIB, 25.9% at stage IIIA, and 9.8% at stage IIA. BVI was found in 45.5% of the tumors (V1), and 18.8% exhibited both lymphatic invasion and BVI (L1V1). Local recurrence occurred in 10.7% of the patients, distant metastasis in 24.1%, and both forms of tumor progression simultaneously in a further 7.1%. Thus 31.2% of the patients developed distant metastases by hematogenous spread (to the brain, bones, lung, adrenal, and liver, in descending order of frequency), mostly within two years of surgery. Late metastasis is not typical of NSCLC. Adenocarcinomas showed a strong tendency to be associated with a poorer prognosis than squamous cell carcinomas, probably because of their more frequent involvement of blood vessels. Five-year survival (Kaplan-Meier method) was significantly lower in V1 cases (37.2%) than in V0 cases (56.0%; p = 0.0249). Adjuvant mediastinal radiation in node-positive cases of NSCLC may prevent local recurrence but is unlikely to influence the development of distant metastases. The histological detection of BVI is of prognostic relevance and should be considered for inclusion in the staging criteria and indications for adjuvant chemotherapy.

[Actuarial survival and prognostic factors of bronchial cancer]

A total of 1325 patients with bronchogenic carcinoma who were treated at the surgical clinic of the Technical University of Munich between 1981 and 1991 were enrolled in a prospective follow-up study. The 5-year actuarial survival rate of 605 patients with squamous cell carcinoma was 28.2%, of 288 patients with adenocarcinoma 38.0%, of 219 patients with small cell carcinoma 15.4%, of 74 patients with giant cell carcinoma 19.0%, and of 139 patients with other histologic findings 27.8%. In all, 680 patients (51.4%) underwent surgery. Diagnostic thoracotomy without resection was performed in 6.2% of cases. Lethality within 30 days was 1% for lobectomy, 7.3% for bilobectomy, and 7.7% for pneumonectomy including extended resections. The 5-year survival rates among the operated patients were 64.8% for T1N0M0 tumours, 49.4% for T2N0M0, 46.1% for T1N1M0, 43.4% for T2N1M0, 23.8% for T3 and 11.7% for T4. T1N0M0 adenocarcinoma was associated with a better prognosis than squamous cell carcinoma of the same early stage, with a 5-year survival rate of 82.2% vs 55.9%. The prognosis of patients with T3N2 was worse than that of patients with a T3-4 primary tumour but only N0-1 lymph node involvement (5-year survival rate 18.1% vs 31.7%). Stepwise logistic regression analysis identified tumour stage, therapy, and histologic result as the factors with the greatest impact on the prognosis. Adjuvant radiation after resection in patients with T2-3 adenocarcinoma or squamous cell carcinoma improved the prognosis by one tumour stage compared with patients who only underwent surgery. In conclusion, surgical therapy of bronchogenic carcinoma offers favourable survival rates with acceptable risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumor-associated antigen 43-9F is of prognostic value in squamous cell carcinoma of the lung. A retrospective immunohistochemical study

BACKGROUND

Squamous cell lung carcinoma (SLC), the most frequent type of lung cancer, generally is treated surgically and its prognosis is poor. The only current clinically useful prognostic criterion is lymph node staging (TNM classification). Expression of a novel tumor-associated carbohydrate epitope Gal beta 1-3[Fuc alpha 1-4]GlcNAc beta 1-4[Fuc alpha 1-3]GlcNAc beta 1-3 Gal beta 1-4Glc identified by the 43-9F monoclonal antibody (MoAb) is associated with the growth pattern of SLC cell lines in athymic mice and in vitro. This implies that the 43-9F epitope may be related to tumor progression in patients with SLC and that, as such, it could be of prognostic value.

METHODS

Primary tumor specimens from 231 patients with lung carcinoma (130 with SLC, 64 with adenocarcinoma, 10 with small cell carcinoma, 16 with large cell carcinoma, and 11 with adenosquamous carcinoma) were examined by immunohistochemical studies on formalin-fixed, paraffin-embedded tissue samples for immunoreactivity with an MoAb to the 43-9F antigen. Univariate and step-wise Cox regression analyses were used to compare survival time by histopathologic diagnosis, smoker status, TNM classification, and type of surgical treatment.

RESULTS AND CONCLUSIONS

Patients with 43-9F epitope-positive SLC tumors had a significantly (P less than 0.01) better prognosis than patients with epitope-negative tumors. In contrast, no association was seen between 43-9F epitope expression and survival time for patients with lung adenocarcinomas. Further, the prognostic value of 43-9F expression in SLC was found to be superior to the N-classification with the added advantage that it requires access only to primary tumor tissue and thus is available before therapy.