PURPOSE: The survival of patients with non-small-cell lung cancer (NSCLC), even when resectable, remains poor. Several small studies suggest that occult metastases (OMs) in pleura, bone marrow (BM), or lymph nodes (LNs) are present in early-stage NSCLC and are associated with a poor outcome. We investigated the prevalence of OMs in resectable NSCLC and their relationship with survival. PATIENTS AND METHODS: Eligible patients had previously untreated, potentially resectable NSCLC. Saline lavage of the pleural space, performed before and after pulmonary resection, was examined cytologically. Rib BM and all histologically negative LNs (N0) were examined for OM, diagnosed by cytokeratin immunohistochemistry (IHC). Survival probabilities were estimated using the Kaplan-Meier method. The log-rank test and Cox proportional hazards regression model were used to compare survival of groups of patients. P < .05 was considered significant. RESULTS: From July 1999 to March 2004, 1,047 eligible patients (538 men and 509 women; median age, 67.2 years) were entered onto the study, of whom 50% had adenocarcinoma and 66% had stage I NSCLC. Pleural lavage was cytologically positive in only 29 patients. OMs were identified in 66 (8.0%) of 821 BM specimens and 130 (22.4%) of 580 LN specimens. In univariate and multivariable analyses OMs in LN but not BM were associated with significantly worse disease-free survival (hazard ratio [HR], 1.50; P = .031) and overall survival (HR, 1.58; P = .009). CONCLUSION: In early-stage NSCLC, LN OMs detected by IHC identify patients with a worse prognosis. Future clinical trials should test the role of IHC in identifying patients for adjuvant therapy.
PURPOSE: The survival of patients with non-small-cell lung cancer (NSCLC), even when resectable, remains poor. Several small studies suggest that occult metastases (OMs) in pleura, bone marrow (BM), or lymph nodes (LNs) are present in early-stage NSCLC and are associated with a poor outcome. We investigated the prevalence of OMs in resectable NSCLC and their relationship with survival. PATIENTS AND METHODS: Eligible patients had previously untreated, potentially resectable NSCLC. Saline lavage of the pleural space, performed before and after pulmonary resection, was examined cytologically. Rib BM and all histologically negative LNs (N0) were examined for OM, diagnosed by cytokeratin immunohistochemistry (IHC). Survival probabilities were estimated using the Kaplan-Meier method. The log-rank test and Cox proportional hazards regression model were used to compare survival of groups of patients. P < .05 was considered significant. RESULTS: From July 1999 to March 2004, 1,047 eligible patients (538 men and 509 women; median age, 67.2 years) were entered onto the study, of whom 50% had adenocarcinoma and 66% had stage I NSCLC. Pleural lavage was cytologically positive in only 29 patients. OMs were identified in 66 (8.0%) of 821 BM specimens and 130 (22.4%) of 580 LN specimens. In univariate and multivariable analyses OMs in LN but not BM were associated with significantly worse disease-free survival (hazard ratio [HR], 1.50; P = .031) and overall survival (HR, 1.58; P = .009). CONCLUSION: In early-stage NSCLC, LN OMs detected by IHC identify patients with a worse prognosis. Future clinical trials should test the role of IHC in identifying patients for adjuvant therapy.
Authors: Robin T Vollmer; James E Herndon; Jonathan D'Cunha; Naif Z Abraham; Joette Solberg; Mitra Fatourechi; Ann Maruska; Jeffrey A Kern; Mark R Green; Robert A Kratzke; Michael A Maddaus Journal: Clin Cancer Res Date: 2003-11-15 Impact factor: 12.531
Authors: Massimo Cristofanilli; G Thomas Budd; Matthew J Ellis; Alison Stopeck; Jeri Matera; M Craig Miller; James M Reuben; Gerald V Doyle; W Jeffrey Allard; Leon W M M Terstappen; Daniel F Hayes Journal: N Engl J Med Date: 2004-08-19 Impact factor: 91.245
Authors: B Passlick; J R Izbicki; B Kubuschok; W Nathrath; O Thetter; U Pichlmeier; L Schweiberer; G Riethmüller; K Pantel Journal: J Clin Oncol Date: 1994-09 Impact factor: 44.544
Authors: R J Cote; E J Beattie; B Chaiwun; S R Shi; J Harvey; S C Chen; A E Sherrod; S Groshen; C R Taylor Journal: Ann Surg Date: 1995-10 Impact factor: 12.969
Authors: K Pantel; J R Izbicki; M Angstwurm; S Braun; B Passlick; O Karg; O Thetter; G Riethmüller Journal: Cancer Res Date: 1993-03-01 Impact factor: 12.701
Authors: Jun-ichi Nitadori; Adam J Bograd; Kyuichi Kadota; Camelia S Sima; Nabil P Rizk; Eduardo A Morales; Valerie W Rusch; William D Travis; Prasad S Adusumilli Journal: J Natl Cancer Inst Date: 2013-08-07 Impact factor: 13.506
Authors: Robert D Timmerman; Rebecca Paulus; Harvey I Pass; Elizabeth M Gore; Martin J Edelman; James Galvin; William L Straube; Lucien A Nedzi; Ronald C McGarry; Cliff G Robinson; Peter B Schiff; Garrick Chang; Billy W Loo; Jeffrey D Bradley; Hak Choy Journal: JAMA Oncol Date: 2018-09-01 Impact factor: 31.777
Authors: Raymond U Osarogiagbon; Holly L Hilsenbeck; Elizabeth W Sales; Allen Berry; Robert W Jarrett; Christopher S Giampapa; Clara N Finch-Cruz; David Spencer Journal: Transl Lung Cancer Res Date: 2015-08
Authors: Usman Ahmad; Traves D Crabtree; Aalok P Patel; Daniel Morgensztern; Cliff G Robinson; A Sasha Krupnick; Daniel Kreisel; David R Jones; G Alexander Patterson; Bryan F Meyers; Varun Puri Journal: Ann Thorac Surg Date: 2017-04-19 Impact factor: 4.330