|
Preoperative serum
carcinoembryonic antigen level is a prognostic factor in women with
early non-small-cell lung cancer. Ann
Thorac Surg. 2007 Feb;83(2):419-24.
BACKGROUND: Carcinoembryonic antigen (CEA) is one of the markers
evaluated in patients with non-small cell lung cancer (NSCLC). The
significance of the preoperative serum CEA level in female patients
with NSCLC is seldom discussed. In this study, we conducted a
retrospective review to investigate the prognostic significance of the
preoperative CEA level in female patients with stage I NSCLC. METHODS:
In this study, we looked at 163 female patients with stage I NSCLC.
Patient charts were reviewed to collect patient data, including the
age of the patient, tumor location, tumor size, visceral pleural
invasion, the stage of disease, and the preoperative serum CEA level.
The cutoff value of serum CEA level was 6.0 ng/mL. The significance of
preoperative CEA level in the prognosis of female patients with stage
I NSCLC was evaluated. RESULTS: Among the 163 female patients with
stage I NSCLC, 47 patients (28.8%) had abnormal preoperative serum CEA
level (>6 ng/mL). Diagnosis of adenocarcinoma and bronchoalveolar
carcinoma accounted for 83.4% of these 163 female patients.
In-hospital mortality was encountered in 1 patient. Univariate
analysis of survival in the other 162 female patients with stage I
NSCLC showed that age, stage, tumor size, and preoperative CEA level
were prognostic factors. Visceral pleural invasion had no impact on
the prognosis of these patients. Multivariate analysis revealed that
tumor size and preoperative CEA level were independent prognostic
factors in female patients with stage I NSCLC. CONCLUSIONS:
Preoperative serum CEA level and tumor size are independent prognostic
factors in female patients with stage I NSCLC. In contrast, visceral
pleural invasion was not associated with the prognosis. Importantly,
these results suggest that female patients with abnormally high
preoperative CEA level and tumor size larger than 3 cm may need a
thorough preoperative evaluation and careful postoperative follow-up
to rule out occult metastasis of early NSCLC.
Clinicopathologic
study of resected, peripheral, small-sized, non-small cell lung cancer
tumors of 2 cm or less in diameter: pleural invasion and increase of
serum carcinoembryonic antigen level as predictors of nodal
involvement.J
Thorac Cardiovasc Surg. 2006
May;131(5):988-93.
OBJECTIVE: The
number of surgical interventions for small-sized lung cancer has
increased with the development of computed tomography. We attempted to
identify clinicopathologic characteristics of peripheral, small-sized,
non-small cell lung cancer to show the limitation of partial resection
or segmentectomy. METHODS: A retrospective analysis of 143 patients
who underwent a complete resection for a peripheral non-small cell
lung cancer of 2 cm or less in diameter was performed. The
relationships between nodal involvement and other clinical factors
were also assessed in patients who underwent a lobectomy plus node
dissection. RESULTS: The overall 5-year survival rate was 88.1%. The
5-year survival rate was 100% for patients with a tumor of 1.5 cm or
less. Survival for patients with adenocarcinoma histology was
significantly better than for those with nonadenocarcinoma histology
(P = .03). The 5-year survival rate for patients without lymph node
metastases was 91.6%, whereas it was 62.5% for those with nodal
involvement (P < .01). Increase of prethoracotomy serum
carcinoembryonic antigen level was an independent predictor of a poor
prognosis. Lymph node metastasis was significantly increased in those
with pleural invasion by the primary lesion and increased serum
carcinoembryonic antigen level. Fourteen (16.9%) of 83 patients with a
tumor diameter of larger than 1.5 cm had nodal metastasis.
CONCLUSIONS: Nodal involvement should be considered in patients with
non-small cell lung cancer of 2 cm or less in diameter who show
pleural invasion or an increased carcinoembryonic antigen level. A
lobectomy with node dissection is recommended for patients with a
tumor larger than 1.5 cm, suspected pleural invasion, or
prethoracotomy carcinoembryonic antigen level increase.
Non-small cell lung cancer in the young: a retrospective analysis of
diagnosis, management and outcome data. Anticancer
Res. 2006 Jul-Aug;26(4B):3175-81.
BACKGROUND:
Non-small cell lung cancer (NSCLC) in young patients is uncommon and
is thought to constitute a distinct oncological entity with
characteristic clinicopathological patterns. Since the reported data
are scant and discordant, the presentation, management and outcome
data of NSCLC patients aged under 45 years of age were analyzed and
compared with those of patients over 45 years old. Prognostic factors
for risk classification were also evaluated. MATERIALS AND METHODS:
The data were abstracted from the Hellenic Cooperative Oncology Group
(HeCOG) cancer registry database. The presentation, management and
outcome data of patients with histologically confirmed NSCLC, managed
from 1989 until 2004 in HeCOG participating centers, were
retrospectively analyzed. The clinicopathological characteristics of
patients aged < and > than 45 years old were compared and evaluated
for prognostic significance regarding outcome. RESULTS: The data for
NSCLC patients (1906), of whom 115 were aged <45, were retrieved. In
comparative analysis, the young patients were more frequently
asymptomatic at diagnosis, while older patients presented
significantly higher rates of thoracic pain, cough and fatigue
(p<0.01). The young patients were more commonly diagnosed with
adenocarcinoma and less frequently with squamous cancer than patients
aged over 45. Although the stage distribution was distinct, with older
patients presenting higher rates of stage IV disease (21.9% vs.
12.2%), the rates of early lung cancer (stages I-IIIa) were similar.
The overall survival (OS) was not significantly different (median OS
12 vs. 11.5 months, p=0.277). Among patients who underwent first-line
palliative chemotherapy, young individuals had a significantly shorter
time to progression: 4.3 vs. 5.8 months (p=0.0049). Univariate and
multivariate regression analyses established the prognostic usefulness
of the performance status, disease stage and disease-free interval for
the risk of death, both in the total number of patients (1906) and in
young patients (115). CONCLUSION: This large retrospective series
failed to present strong evidence that NSCLC among young individuals
constitutes a distinct clinicopathological entity with differing
biological behavior, since the same clinicopathological prognostic
factors were valid in both age groups. Molecular phenotypic studies
are needed to shed light on this controversial subject.
Impact of large tumor
size on survival after resection of pathologically node negative (pN0)
non-small cell lung cancer.
Ann Thorac Surg. 2005 Apr;79(4):1142-6.
BACKGROUND: The
current TNM staging system first adopted the tumor size of 3 cm for
subdivision of stage I and II disease. The aim of the present study
was to evaluate the impact of tumor size on survival in patients with
pathologically node negative (pN0) non-small cell lung cancer after
complete resection. METHODS: We retrospectively reviewed the records
of 603 patients with pN0 non-small cell lung cancer patients (403 men
and 200 women) who underwent a complete resection in five national
chest hospitals between 1992 and 1996, with follow-up duration of more
than 5 years, and analyzed tumor size and survival. Survival rate was
estimated by the Kaplan-Meier method, and differences were compared by
log-rank test. For the multivariate analysis, the Cox proportional
hazard model was used to identify variables that significantly
affected survival. RESULTS: There were 355 adenocarcinomas, 208
squamous cell carcinomas, and 40 large cell carcinomas completely
resected. No significant prognostic differences were seen among three
groups with smaller-sized tumors (< or =2 cm [n = 171], 2.1 to 3 cm [n
= 202], and 3.1 to 5 cm [n = 170]); however, patients with a tumor
size greater than 5 cm (n = 60) showed a significantly worse
prognosis. The 5-year survival rates were 79.6%, 72.7%, 68.1%, and
46.6%, respectively, in these four groups. Multivariate analysis
showed the tumor size to be an independent prognostic predictor in
patients with pN0 tumors. CONCLUSIONS: We found that a tumor size of
greater than 5 cm was an independent prognostic predictor in pN0
disease; therefore, upgrading the T factor of tumor diameter to
greater than 5 cm may be necessary in the next reversion of the TNM
staging system.
Prognostic
factors in patients with ipsilateral pulmonary metastasis from
non-small cell lung cancer.Eur
J Cardiothorac Surg. 2005
Oct;28(4):635-9.
OBJECTIVE:
Pulmonary metastasis of non-small cell lung cancer is classified as an
advanced disease stage, with limited indications for surgical
treatment. However, the prognosis of patients with pulmonary
metastasis of non-small cell lung cancer is better than that of
patients with distant metastases. The purpose of the present study was
to analyze and detect possible prognostic factors in surgically
treated patients with ipsilateral pulmonary metastasis of non-small
cell lung cancer. METHODS: Among 1198 patients with non-small cell
lung cancer who underwent surgery at Kurashiki Central Hospital
(Okayama, Japan) from April 1982 to March 2004, a total of 48 (4.0%)
patients with pathologically diagnosed ipsilateral pulmonary
metastasis were retrospectively evaluated. The median follow-up time
was 20.5 months (range 1-103 months) and 37 patients (77.1%) were
completely followed up until their death or more than 5 years after
the operation. RESULTS: Among the 48 patients, 31 (64.6%) patients had
metastatic nodules in the same lobe as the primary tumor (PM1) and 17
(35.4%) patients had metastatic nodules in different ipsilateral lobes
(PM2). There was no significant difference in survival between
patients with PM1 and the other patients with pT4-stage IIIB, or
between patients with ipsilateral PM2 and the other patients with
stage IV. Univariate analysis of postoperative survival stratified
according to clinicopathologic factors revealed significant
differences for the radicality of resection (complete vs. incomplete),
tumor size (0-30 vs. >30mm) and pathological nodal (pN) factor (among
pN0, pN1 and pN2-3). Multivariate analysis revealed that tumor size
(0-30 vs. >30mm) and pN factor (pN0-1 vs. pN2-3) were independent
prognostic factors. CONCLUSIONS: The results of our study suggest that
undergoing a complete resection, having a tumor size of 30mm or less
and having no mediastinal lymph node metastases were better prognostic
factors for surgically treated patients with ipsilateral pulmonary
metastasis of non-small cell lung cancer.
Pattern of recurrence after curative resection of local (stage I
and II) non-small cell lung cancer: difference according to the
histologic type.
J
Korean Med Sci. 2004 Oct;19(5):674-6.
The aim of the
present study was to evaluate the pattern of recurrence after complete
resection of pathological stage I, II non-small cell lung cancer,
especially according to the cell type. We reviewed the clinical
records of 525 patients operated on for pathologic stage I and II lung
cancer. The histologic type was found to be squamous in 253 and non-squamous
in 229 patients. Median follow-up period was 40 months. Recurrences
were identified in 173 (36%) of 482 enrolled patients; distant
metastasis in 70%, distant and local recurrence in 11%, and local
recurrence in 19%. Distant metastasis was more common in non-squamous
than in squamous cell carcinoma (p=0.044). Brain metastasis was more
frequently identified in non-squamous than in squamous cell carcinoma
(24.2% vs. 7.3%. p=0.005). Multivariate analyses showed that cell type
is the significant risk factor for recurrence-free survival in stage I
and stage II non-small cell lung cancer. Recurrence-free survival
curves showed that non-squamous cell carcinoma had similar risks
during early periods of follow-up and more risks after 2 yr from the
operation compared to squamous cell carcinoma. Pathological stage and
histologic type significantly influence recurrence-free survival.
Long-term results
of pathological stage I non-small cell lung cancer: validation of
using the number of totally removed lymph nodes as a staging control.Eur
J Cardiothorac Surg. 2003
Dec;24(6):994-1001.
OBJECTIVE: The
number of totally removed lymph nodes during thoracotomy was used
alternatively to represent the quality of lymphadenectomy in patients
with pathologic stage I non-small cell lung cancer (NSCLC). We
combined this new parameter with other well-established prognostic
factors and performed multivariate survival analyses to validate its
usage as a stage control. METHODS: Three hundred and twenty-one
patients who underwent complete surgical resection for stage I NSCLC
were reviewed retrospectively. Aside from the number of lymph nodes
removed during thoracotomy, other well-known clinical and
histopathological factors were also included as possible prognostic
factors for analysis. Two survival analyses, overall death and
cancer-related death as study end-point, were performed, using the
Kaplan-Meier method and multivariable Cox's proportional hazard
regression analysis. Stepwise method of variable selection was
employed to choose the 'best' Cox proportional hazard model in each
survival analysis. RESULTS: The overall 5- and 10-year survival rates
were 48 and 35%, and the cancer-related 5- and 10-year survival rate
was 63.3 and 58.3%, respectively. The number of totally removed lymph
nodes during thoracotomy, tumor size and smoking history in
multivariable analysis significantly affected both overall and
cancer-related survival rates. Cell type of adenocarcinoma or large
cell carcinoma was associated with a worse cancer-related survival
compared with other histological types. CONCLUSIONS: The quality of
lymphadenectomy, represented quantitatively by the number of totally
removed lymph nodes during thoracotomy, may impact on a more accurate
tumor stage, and will affect the survival rate for patients with stage
I NSCLC as well as other well known clinical and histopathological
factors.
Characteristics and
prognosis of patients after resection of nonsmall cell lung carcinoma
measuring 2 cm or less in greatest dimension.
Cancer. 2003 Aug 1;98(3):535-41.
BACKGROUND: There
remains ongoing controversy with regard to the optimal management
strategy and the prognostic significance of small-sized nonsmall cell
lung carcinoma. Therefore, in the current study, the authors analyzed
the clinical characteristics of patients who underwent complete
resection of these lung tumors, the follow-up data, and the
significant prognostic factors. METHODS: Of 1726 consecutive patients
surgically treated for proven primary lung carcinoma, 265 patients
underwent complete removal of a nonsmall cell lung carcinoma in which
the greatest dimension of the resected specimen was < or = 2 cm.
RESULTS: The cancer-specific 5-year and 10-year survival rates were
86% and 83%, respectively. Univariate analyses revealed that advanced
pathologic stage, a tumor size of 16-20 mm, lymphatic vessel invasion,
vascular vessel invasion, a high serum level of carcinoembryonic
antigen (CEA), and extended resection were significantly unfavorable
prognostic factors. Among these factors, multivariate analyses
demonstrated that pathologic stage (P < 0.0001), vascular vessel
invasion (P = 0.0040), and CEA level (P = 0.0291) were significant,
independent determinants of survival. None of the patients with
pathologic Stage I disease, no vascular vessel invasion, and a low
serum CEA level died of their disease after undergoing complete
resection. CONCLUSIONS: The preoperative level of serum CEA and
vascular vessel invasion by tumor cells were found to be independent
prognostic factors that were as significant as the well established
determinant of pathologic stage for patients with a nonsmall cell lung
carcinoma measuring < or = 2 cm in greatest dimension. These data may
contribute to the explanation of the lower-than-expected survival of
patients after complete surgical resection of such a small-sized
tumor.
The prognostic
significance of intranodal isolated tumor cells and micrometastases in
patients with non-small cell carcinoma of the lung.J
Thorac Cardiovasc Surg. 2003
Aug;126(2):551-7.
OBJECTIVE: To
study whether isolated tumor cells and micrometastases, as defined by
the current American Joint Committee on Cancer criteria for
extrapulmonary neoplasms, have prognostic value for patients with
resected non-small cell carcinoma of the lung. METHODS: Intrathoracic
lymph nodes (n = 1063) from 60 patients with non-small cell carcinoma
of the lung were studied for the presence of metastases with serial
histologic sections and keratin immunostains. Metastases were
classified as isolated tumor cells, pN1mi, pN1, pN2mi, and pN2.
Isolated tumor cells were smaller than 0.2 mm, while pN1mi and pN2mi
measured 0.2 mm to 2 mm. Survival analysis was performed, stratifying
by nodal status and stage. RESULTS: Isolated tumor cells were detected
in 11 lymph nodes from 5 of 33 pN0 patients and in 9 pN1 and pN2
patients. The lymph nodes from 3 patients were reclassified as pN1mi.
No pN2mi were detected. A survival model based on a stratification of
the cohort into stages I to III was significant (chi-square = 7.426,
df = 2, P =.024) but demonstrated considerable overlap between the
survival curves of stage I and II patients. A model stratifying
isolated tumor cells and pN1mi into stage I disease was significant
(chi-square = 7.985, df = 2, P =.018) and showed no overlap between
the survival curves of stage I and II patients. There were no
significant survival function differences between patients with pN0,
isolated tumor cells, and pN1mi. CONCLUSIONS: Patients with non-small
cell carcinoma of the lung with isolated tumor cells and pN1mi have
similar survivals to those with pN0, consistent with the findings
reported for breast cancer patients. Future larger studies of patients
with non-small cell carcinoma of the lung are needed to confirm
whether current American Joint Committee on Cancer staging criteria
should be modified to include the pN1mi category.
Prognostic
markers in resectable non-small cell lung cancer: a multivariate
analysis. Can
J Surg. 2001 Jun;44(3):180-8.
OBJECTIVE: To
identify the prognostic significance of certain clinical, cellular and
immunologic markers in resectable non-small cell lung cancer (NSCLC).
DESIGN: A cohort of patients with resectable NSCLC was prospectively
followed up for 8 years (100% follow-up). SETTING: A university
hospital in a large Canadian city. PATIENTS: One hundred and thirteen
consecutive patients who underwent surgical resection of primary NSCLC.
MAIN OUTCOME MEASURES: Presence of peritumoral B lymphocytes
(identified with antibody to CD20) and T lymphocytes (antibody to
CD43), along with tumour markers (carcinoembryonic antigen [CEA],
keratin, cytokeratin, S-100 protein, vimentin, chromogranin) and other
factors such as age, sex, cell type, American Joint Committee on
Cancer (AJCC) stage, histologic grade, DNA ploidy and S-phase fraction
were correlated with survival. RESULTS: The mean age of patients in
the study was 66.0 years; 60% were male. Histologic types of the
tumours were: adenocarcinoma 57 (50.4%), squamous cell 47 (41.6%),
adenosquamous 6 (5.3%) and large cell 3 (2.6%). AJCC stages were: I 66
(58.4%), II 20 (17.7%) and III 27 (23.9%). Histologic grades were: I
(well differentiated) 31 (27.4%), II 50 (44.2%), III 29 (25.7%) and IV
3 (2.6%). Survival was 85% at 1 year (95% confidence interval [CI]
76%-90%), 44% at 5 years (95% CI 34%-53%) and 34% at 10 years (95% CI
22%-46%). Multivariate analyses using the Cox proportional hazards
model for survival confirmed AJCC stage (p < 0.001) in all histologic
subtypes to be the strongest factor of independent prognostic
significance. It also revealed the presence of CD20-stained B
lymphocytes (p = 0.04) in the peritumoral region of all tumours to be
a positive prognostic factor. This relation was especially strong for
nonsquamous cell carcinomas (p < 0.001). For squamous cell carcinomas,
the immunohistochemical presence of CEA was of marginally negative
prognostic value (p = 0.04). DNA ploidy and a high S-phase fraction
showed no evidence of prognostic value for stage I tumours, but for
stages II and III tumours there was strong evidence of prognostic
value (p < 0.001 jointly). The evidence for DNA ploidy was especially
strong in stages II and III squamous cell tumours (p = 0.008), and for
a high S-phase fraction was strongest in stages II and III nonsquamous
cell tumours (p = 0.002). CONCLUSIONS: AJCC stage remains the most
important prognostic indicator from a variety of clinical variables
and tumour markers in postoperative patients with resectable NSCLC.
For nonsquamous cell lung carcinomas, the presence of peritumoral B
lymphocytes was strongly associated with improved survival, suggesting
an important role for humoral mediated immunity.
Predictive
survival markers in patients with surgically resected non-small cell
lung carcinoma.Clin
Cancer Res. 2000 Mar;6(3):1125-34.
Among patients
with resected non-small cell lung carcinoma, about 50% will present a
tumor recurrence. Thus, it would be of major importance to be able to
predict and try to prevent these relapses by an active chemotherapy
and/or radiotherapy. In an attempt to answer this question, the tumors
of 227 patients with a surgically resected non-small cell lung
carcinoma were evaluated as follows: tumors were classified as
squamous cell carcinoma (n = 132) or adenocarcinoma (n = 95), and
tumor differentiation was evaluated for each type. Then, all tumors
were classified in respect to their pathological TNM staging (WHO) and
screened by immunohistochemistry for the detection of the expression
of the following antigens: Bcl-2, A+B+H blood group antigens,
c-erb-b2, p53, and Pan-Ras antigens. Furthermore, adenocarcinomas were
screened for the presence of point mutations in Ki-Ras codons 1-31.
Finally, the patient blood group was defined, and patient survival was
analyzed using nonparametric tests and proportional hazard Cox models.
Using Kaplan-Meier survival curves, disease pathological TNM staging
was shown to be a strong predictive factor of survival for both
squamous cell carcinoma and adenocarcinoma. Patients with squamous
cell carcinoma experienced fewer relapses than those with
adenocarcinoma (42% versus 63%; P = 0.0002) and had a significantly
better survival. All evaluated antigens were more often present in
squamous cell carcinoma than in adenocarcinoma except for Pan-Ras
(three times more frequent in adenocarcinoma). In patients with
squamous cell carcinoma, only tumor staging had a significant
prognosis value (P = 0.01). In patients with lung adenocarcinoma, a
well-differentiated tumor (P = 0.009) as well as a positive Bcl-2
staining (P = 0.009) and an A+B+H antigen tumor staining (P = 0.024)
were associated with a better survival. In contrast, patients with a
stage I or II disease and a p53-positive tumor staining and patients
with the O blood group (P = 0.01) had a shorter survival.
Interestingly, no relation with patient survival was related to
c-erb-b2 and Pan-Ras staining. Finally, 12 point mutations were found
out of 81 tumors (15%) evaluated for Ki-Ras codons 1-31; they involved
codon 12 but also 8, 14, and 15 without any relationship to survival.
In respect to lung adenocarcinoma, using Cox proportional hazard
models stratified on tumor staging, the following markers were shown
to be related to survival: (a) Independent markers of longer survival
(ie., high histological degree of tumor differentiation and positive
Bcl-2 and A+B+H blood group antigen expression by tumor cells); and
(b) Independent markers of shorter survival (i.e., O blood group for
all patients and p53 tumor staining in patients with stage I and II
diseases). This study suggests that, in patients who undergo surgery
for lung adenocarcinoma, the presence or absence of these criteria
could be used to define a subset of patients who may benefit from a
more specific follow-up.
Conventional
clinicopathologic prognostic factors in surgically resected nonsmall
cell lung carcinoma. A comparison of prognostic factors for each
pathologic TNM stage based on multivariate analyses.Cancer.
1999 Nov 15;86(10):1976-84.
BACKGROUND: A
number of prognostic factors have been reported for resected nonsmall
cell lung carcinoma. None of them, however, has been reported to have
greater prognostic impact than the pathologic TNM staging system. The
authors evaluated 18 conventional clinicopathologic prognostic factors
in each pathologic stage. METHODS: A retrospective study was conducted
on surgically resected 836 lung carcinoma patients, and the following
conventional prognostic factors were evaluated in multivariate
analyses: age, gender, pack-year smoking, serum carcinoembryonic
antigen and squamous cell carcinoma antigen levels, laterality of
tumor, clinical N status, histologic type of tumor, greatest tumor
dimension, grade of differentiation, pleural involvement, lymphatic
invasion, vascular invasion, degree of fibrosing scarring, nuclear
atypia, mitotic activity, and curativity of resection. RESULTS: The
overall 5-year survival rate was 63.8%. In 430 cases of pathologic
Stage I disease, multivariate analyses revealed 3 significant
prognostic factors: clinical N status (P < 0.001), vascular invasion
(P = 0.001), and curativity of resection (P < 0.001). In 406 cases of
more advanced disease, i.e., pathologic Stage II, IIIA, IIIB, or IV,
multivariate analyses revealed 4 factors as significant: histology (P
= 0.001), pathologic N status (P < 0.001), tumor size (P < 0.001), and
curativity of resection (P = 0.002). CONCLUSIONS: Conventional
clinicopathologic prognostic factors had a different impact on
prognosis in each pathologic TNM stage among patients who underwent
surgical resection of nonsmall cell lung carcinoma. These factors
should be analyzed separately in each pathologic TNM stage.
Pathological and
radiological correlation of endobronchial neoplasms: part II,
malignant tumors. Ann Diagn Pathol 1998;2:31–34.
The majority of
lung neoplasms are malignant. Many of these are central and have an
associated endobronchial component. Most such neoplasms are of surface
epithelial origin; however, neoplasms of submucosal gland, mesenchymal,
and lymphoreticular origin may also demonstrate an endobronchial
component. Because of their endobronchial location and associated
symptoms, these patients often present at an earlier stage than purely
parenchymal lung malignancies. The radiographic features in such cases
may be similar to those associated with benign endobronchial tumors;
however, there are certain radiological signs that are more suggestive
of a malignant process. Despite these circumstances, conservative
management such as endoscopic excision are inappropriate in most
instances. The clinicopathologic and radiological features of these
lesions are detailed.
Tumour regression
in non-small-cell lung cancer following neoadjuvant therapy.
Histological assessment. J
Cancer Res Clin Oncol.
1997;123(9):469-77.
In the scope of a
prospective multi-centre study after neoadjuvant combined chemotherapy
(carboplatin, ifosfamide, etoposide, vindesine) and radiotherapy (45
Gy) 40 resection specimens of locally advanced non-small-cell lung
cancer were analysed in order to establish reproducible
pathological/anatomical results of tumour regression. Resection
specimens of 28 squamous cell carcinomas and 12 adenocarcinomas were
investigated using serial sections of the primary lesion. The mean age
of the patients was 57 years. The results were compared to spontaneous
regressive changes in a control group of 50 untreated non-small-cell
lung cancers. Marked scarry fibrosis in the region of the former
primary tumour, concentric foci of fresh tumour necroses and
surrounding foam cell clusters with transition into vascular
granulation tissue could be established as characteristic features of
therapy-induced tumour regression, whereas untreated carcinomas
revealed necroses with adjoining vital tumour tissue. Using a
three-step regression system, 3 tumours could be classified as grade I
(no or only slight tumour regression), 10 tumours as grade IIA (marked
but incomplete tumour regression, more than 10% vital tumour tissue),
20 tumours as grade IIB (less than 10% vital tumour tissue) and 7
tumours as grade III (complete tumour regression without vital tumour
tissue). After a median follow-up period of 32.3 months in patients
with grade IIB or III tumour regression ("responders") the median
survival time of 27.9 months was found to be significantly longer than
in patients with grade I or IIA tumour regression ("non-responders")
with a median survival period of 13.7 months (log-rank test, P =
0.020). The resection specimens analysed, which were obtained 7 weeks
(on average) after the end of radiochemotherapy, did not show specific
changes due to preoperative therapy, but quite characteristic
histological alterations in the former tumour area were registered,
which had been induced by combined neoadjuvant radiation and
chemotherapy. The grade of therapy-induced tumour regression could be
shown to be a significant prognostic factor in non-small-cell lung
cancer.
How reliable is
the diagnosis of lung cancer using small biopsy specimens? Report of a
UKCCCR Lung Cancer Working Party.Thorax.
1993 Nov;48(11):1135-9.
BACKGROUND--A
study was undertaken to investigate the accuracy of typing of a series
of bronchial carcinomas by experienced pathologists with an interest
in lung cancer from the examination of bronchoscopic biopsy specimens.
METHODS--Eighty bronchial biopsy specimens showing positive results
for bronchial carcinoma were circulated to five pathologists, who
recorded diagnostic criteria and diagnosis for each. Diagnoses were
then compared with the diagnosis agreed from the resection specimen
corresponding to each biopsy specimen. A "non-small cell carcinoma,
not further specified" classification group was introduced for small
biopsy specimens. RESULTS--A diagnostic accuracy of 75% was achieved
for squamous cell carcinomas, 66% for small cell carcinomas, and 50%
for adenocarcinomas. There was diagnostic confusion between small cell
and non-small cell carcinoma in less than 10% of cases. The
introduction of a non-specific non-small cell classification improved
diagnostic accuracy by 10-15% for each non-small cell tumour group.
CONCLUSIONS--There are appreciable inaccuracies in applying the World
Health Organisation's 1981 classification of lung cancer to the
diagnosis of bronchial carcinoma from small biopsy specimens and these
inaccuracies have been measured. They can be diminished by introducing
a less specific "non-small cell" category for use with this sort of
biopsy material. Care should be taken not to overinterpret small
biopsy specimens in lung cancer.
|
