INTRODUCTION: Non-small cell lung cancer has a poor prognosis, including those with operable, apparently localised, disease. Preoperative staging investigations and histo-pathological analysis are poor at detecting small clusters of tumour cells, particularly in lymph nodes. STATE OF THE ART: New methods based on immunohistochemistry, or molecular biology, have been developed to detect these so-called micro-metastases. We present a ten-year review of the literature published on this topic. PERSPECTIVE: These publications primarily reported on the detection of micro-metastases within mediastinal lymph nodes removed at operation in order to identify patients at risk of recurrence, for whom adjuvant therapy might be offered. CONCLUSIONS: Lymph node micro-metastases have been demonstrated to be an independent prognostic factor for survival, especially in stage I patients. On the other hand, the presence of bone marrow micro-metastases did not appear to be of significant prognostic value in non-small-cell lung cancer. Finally, the clinical relevance of circulating tumour cells is still debatable, although recent published studies show interesting results.
INTRODUCTION:Non-small cell lung cancer has a poor prognosis, including those with operable, apparently localised, disease. Preoperative staging investigations and histo-pathological analysis are poor at detecting small clusters of tumour cells, particularly in lymph nodes. STATE OF THE ART: New methods based on immunohistochemistry, or molecular biology, have been developed to detect these so-called micro-metastases. We present a ten-year review of the literature published on this topic. PERSPECTIVE: These publications primarily reported on the detection of micro-metastases within mediastinal lymph nodes removed at operation in order to identify patients at risk of recurrence, for whom adjuvant therapy might be offered. CONCLUSIONS: Lymph node micro-metastases have been demonstrated to be an independent prognostic factor for survival, especially in stage I patients. On the other hand, the presence of bone marrow micro-metastases did not appear to be of significant prognostic value in non-small-cell lung cancer. Finally, the clinical relevance of circulating tumour cells is still debatable, although recent published studies show interesting results.
Authors: Michael P Mac Manus; Rodney J Hicks; Jane P Matthews; Allan McKenzie; Danny Rischin; Eeva K Salminen; David L Ball Journal: J Clin Oncol Date: 2003-04-01 Impact factor: 44.544
Authors: Gerald Antoch; Jörg Stattaus; Andre T Nemat; Simone Marnitz; Thomas Beyer; Hilmar Kuehl; Andreas Bockisch; Jörg F Debatin; Lutz S Freudenberg Journal: Radiology Date: 2003-09-25 Impact factor: 11.105
Authors: Didier Lardinois; Walter Weder; Thomas F Hany; Ehab M Kamel; Stephan Korom; Burkhardt Seifert; Gustav K von Schulthess; Hans C Steinert Journal: N Engl J Med Date: 2003-06-19 Impact factor: 91.245