Yasuhiro Tsutani1, Shuji Murakami2, Yoshihiro Miyata1, Haruhiko Nakayama2, Masahiro Yoshimura3, Morihito Okada4. 1. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. 2. Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan. 3. Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan. 4. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan morihito@hiroshima-u.ac.jp.
Abstract
OBJECTIVE: This multicentre study aimed to investigate the predictors of pathological lymph node status in patients with clinical stage IA squamous cell carcinoma of the lung, to select candidates for sublobar resection. METHODS: In total, we analysed 100 patients with clinical stage IA squamous cell carcinoma of the lung who underwent lobectomy or segmentectomy with systematic lymph node dissection. The relationship between lymph node status and tumour size on computed tomography, maximum standardized uptake value (SUV) on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) and serum tumour markers were examined. RESULTS: Lymph node metastases were present in 12% of the study subjects, and 54% had evidence of pathological tumour invasiveness such as lymph node metastasis and/or lymphatic, vascular or pleural invasion. The areas under the receiver operating characteristic (ROC) curves for tumour size, maximum SUV, serum carcinoembryonic antigen and serum cytokeratin-19 fragments used to predict lymph node metastasis were 0.54 (P = 0.69), 0.46 (P = 0.67), 0.47 (P = 0.74) and 0.42 (P = 0.37), respectively. After multivariate analysis, no independent predictive factors for lymph node metastasis remained among those preoperative parameters. Likewise, we could find no preoperative predictors from either the ROC curves or multivariate analysis for pathological tumour invasiveness. CONCLUSIONS: All examined factors in this dataset were not predictive for lymph node metastasis or pathological invasiveness in patients with clinical stage IA squamous cell carcinoma of the lung. Systematic lymphadenectomy is advisable for this type of tumour.
OBJECTIVE: This multicentre study aimed to investigate the predictors of pathological lymph node status in patients with clinical stage IA squamous cell carcinoma of the lung, to select candidates for sublobar resection. METHODS: In total, we analysed 100 patients with clinical stage IA squamous cell carcinoma of the lung who underwent lobectomy or segmentectomy with systematic lymph node dissection. The relationship between lymph node status and tumour size on computed tomography, maximum standardized uptake value (SUV) on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) and serum tumour markers were examined. RESULTS: Lymph node metastases were present in 12% of the study subjects, and 54% had evidence of pathological tumour invasiveness such as lymph node metastasis and/or lymphatic, vascular or pleural invasion. The areas under the receiver operating characteristic (ROC) curves for tumour size, maximum SUV, serum carcinoembryonic antigen and serum cytokeratin-19 fragments used to predict lymph node metastasis were 0.54 (P = 0.69), 0.46 (P = 0.67), 0.47 (P = 0.74) and 0.42 (P = 0.37), respectively. After multivariate analysis, no independent predictive factors for lymph node metastasis remained among those preoperative parameters. Likewise, we could find no preoperative predictors from either the ROC curves or multivariate analysis for pathological tumour invasiveness. CONCLUSIONS: All examined factors in this dataset were not predictive for lymph node metastasis or pathological invasiveness in patients with clinical stage IA squamous cell carcinoma of the lung. Systematic lymphadenectomy is advisable for this type of tumour.
Authors: Oisin J O'Connell; Francisco A Almeida; Michael J Simoff; Lonny Yarmus; Ray Lazarus; Benjamin Young; Yu Chen; Roy Semaan; Timothy M Saettele; Joseph Cicenia; Harmeet Bedi; Corrine Kliment; Liang Li; Sonali Sethi; Javier Diaz-Mendoza; David Feller-Kopman; Juhee Song; Thomas Gildea; Hans Lee; Horiana B Grosu; Michael Machuzak; Macarena Rodriguez-Vial; George A Eapen; Carlos A Jimenez; Roberto F Casal; David E Ost Journal: Am J Respir Crit Care Med Date: 2017-06-15 Impact factor: 21.405