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Clinical InvestigationsCANCERClinical Predictors of N2 Disease in Non-small Cell Lung Cancer
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Materials and Methods
Between August 1992 and April 1997, 634 lung cancer patients underwent surgical intervention at our institute. Among them, 387 patients had adenocarcinoma or squamous cell carcinoma, and underwent major lung resection and systematic lymph node dissection. They were enrolled in this study. Five of them underwent preoperative mediastinoscopy, which revealed no mediastinal node involvement. The following patients were excluded: (1) patients who had received induction therapy, (2) patients with
Results
The clinical and radiologic characteristics of the patients are presented in Table 1 . There were 237 men and 150 women. The ages ranged from 33 to 84 years, with an average of 63 years. There were 79 among 387 overall patients (20%) with pN2 disease, 61 among 290 adenocarcinoma patients (21%) and 18 among 97 squamous cell carcinoma patients (19%), respectively. The average size of mediastinal lymph node was 6 mm in the shortest axis and 11 mm in the longest axis. Squamous cell carcinoma had
Discussion
Inasmuch as primary surgery for N2 NSCLC resulted in poor outcome, some authors concluded that surgery is contraindicated in N2 disease.22 However, several other studies suggested that induction chemotherapy or chemoradiation followed by surgical resection resulted in pathologic down-staging and better long-term survival in patients with N2 disease.23, 2425 Therefore, accurate preoperative staging of the mediastinum is important in deciding NSCLC treatment strategy.
Several reports advocated
ACKNOWLEDGMENT
The authors thank Dr. Satoshi Sasaki, Epidemiology and Biostatistics Division, National Cancer Center Research Institute East, for his technical support in performing the statistical analyses. We also thank Prof. J. Patrick Barron, International Medical Communications Center, Tokyo Medical University, for reviewing the English manuscript.
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Cited by (68)
Development and validation of a clinical prediction model for N2 lymph node metastasis in non-small cell lung cancer
2013, Annals of Thoracic SurgeryPredictive risk factors for mediastinal lymph node metastasis in clinical stage IA non-small-cell lung cancer patients
2012, Journal of Thoracic OncologyCitation Excerpt :This result might encourage the surgeons conducting prospective studies of intentional sublobar resection for NSCLC patients with a peripheral tumor of 2 cm or less in size.23,24 Several reports have indicated that elevated preoperative serum CEA levels are associated with pathologic upstaging and an unfavorable prognosis after curative surgical resection in NSCLC patients,25,26 and preoperative serum CEA level of 5.0 ng/ml was reported as a risk factor for mediastinal nodal metastasis in the patients with resected adenocarcinoma or squamous-cell carcinoma.10 Even in the present study, preoperative serum CEA level was identified as a predictor for mediastinal nodal metastasis, and the ROC analysis determined the cutoff point at 3.5 ng/ml, despite having set the cutoff for the normal upper limit at 5 ng/ml.
Significance of smoking history and FDG uptake for pathological N2 staging in clinical N2-negative non-small-cell lung cancer
2011, Annals of OncologyCitation Excerpt :After careful review of the CT and PET–CT scans, localizations of lymph nodes to show an enlarged size or avid FDG uptake were recorded using the American Thoracic Society lymph node classification system [16]. A tumor was considered to be central when it is located in the inner one-third of the lung field, and peripheral otherwise [17]. Locoregional lymph nodes were considered positive if the short diameter of discrete nodes was >1 cm or the FDG accumulation intensity was definitely above the surrounding background activity, with a consensus of the two nuclear medicine physicians.
Tumor histology affects the accuracy of clinical evaluative staging in primary lung cancer
2010, Lung CancerCitation Excerpt :Tumor size and the level of serum carcinoembryonic antigen (CEA) may be preoperatively indicators of pathologic upstaging [12,15]. Patients with preoperative positive serum CEA might have occult metastasis [15]. To the contrary, Takamochi et al. reported that squamous cell carcinoma had significantly larger mediastinal lymph nodes, and the lymph node size is not a significant factor in predicting N2 disease [15].
Supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare, Japan.