Outcome following lung resections for pT1 non-small cell lung cancer.

AIMS: To analyse the outcome of patients with pT1 NSCLC treated at our institution by antero-lateral thoracotomy, anatomical lung resections and mediastinal lymph node dissection between 1980 and 2001. METHODS: Follow-up data were obtained retrospectively from 1980 to 1990 and prospectively after 1990. Survival was analysed using the Kaplan-Meier method. RESULTS: Histopathological examinations revealed mediastinal lymph node infiltration in 27.6% (pN1 17.8% and pN2 9.8%). pN2 was classified in 14.1% of adenocarcinomas compared to 6.2% of squamous cell carcinomas. Median overall survival of patients with pT1 carcinomas was 89+16 months (median+standard error). Histopathological N-classification indicates differential prognostic and therapeutic implications in pT1 adeno- and squamous cell carcinomas. CONCLUSIONS: Complete lymph node dissection is required for all patients with T1 NSCLC treated by either open surgery or VATS resection. Histopathological N-classification indicates differential prognostic and therapeutic implications in pT1 adeno- and squamous cell carcinomas.

Morbidity and survival after bronchoplastic surgery for non-small-cell lung cancer.

BACKGROUND: Bronchoplastic procedures are an accepted surgical approach in patients with resectable non-small-cell lung cancer (NSCLC) to avoid pneumonectomy. Post-operative complications associated with the bronchial anastomosis and local recurrence of the tumor have to be considered. Experimental design and setting: Retrospective analysis of the clinical courses and follow-up of 1,610 consecutive patients who received surgical resection for NSCLC at the Department of Surgery, Klinikum Grosshadern, University of Munich, Germany. Among them there were 134 (8.3%) bronchoplastic resections. METHODS: Morbidity, mortality, and survival rate were investigated in these patients to verify the safety of this technique. RESULTS: From all 134 bronchoplastic resections, 105 lobectomies, 22 bilobectomies, and 7 pneumonectumies were performed. Atelectasis was observed in 6.0% (versus conventional procedures: 3.7%; p: n.s.), whereas anastomotic dehiscence occurred in 3.0%. In-hospital mortality amounted to 3.7% (versus 5.3%; p: n.s.). The stage dependent 5-year survival in R0-resected patients was comparable in both groups. CONCLUSIONS: Our results demonstrate that bronchoplastic procedures represent a safe therapeutic option in the operative treatment of non-small-cell lung cancer that should be considered in all patients with central tumor growth.

Mediastinal lymph node infiltration in non-small cell lung cancer and its role in curative surgery.

Despite the importance of lymph node infiltration for the classification and prognosis of non-small cell lung cancer (NSCLC), there are no accepted standards for quality of mediastinal lymphadenectomy. In 270 consecutive patients undergoing potentially curative surgery for NSCLC, including complete ipsilateral lymph node dissection, we investigated the possibility of a correlation between tumour location and lymph node infiltration. The tumours were classified as UICC stage I (n = 115), II (n = 42) or IIIa (n = 113). Patients with N2-disease (n = 68) showed up to 81% skip metastasis. Because of the observed dissemination of lymph node metastasis, tumour location could not predict nodal infiltration. The variability of nodal involvement and the frequent occurrence of skip metastasis thus make complete ipsilateral lymphadenectomy mandatory for curative management of NSCLC.

Pro-gastrin-releasing peptide (ProGRP)--a useful marker in small cell lung carcinomas.

Gastrin-releasing-peptide (GRP), the mammalian counterpart of amphibian bombesin, has been reported to be produced by cells of SCLC. Using recombinant ProGRP Yamaguchi et al developed an enzyme immunoassay for the measurement of this more stable precursor of GRP. We focused our interest on the comparability of ProGRP to neuron specific enolase (NSE), CYFRA 21-1 and CEA. For this purpose we investigated the sera of 272 patients with histologically proven carcinomas of the lung (87 SCLC, 185 NSCLC). The sera of 74 patients with benign diseases of the lung and smokers served as a reference group. At a specificity of 95% ProGRP and NSE possessed comparable sensitivities (47% versus 45%) in small cell lung carcinomas. ProGRP showed only a few more positive test results than NSE, but reached much higher value levels than NSE. ProGRP and NSE showed a clear additive sensitivity of about 20%. In NSCLC CYFRA 21-1 was the leading marker with 63% sensitivity, whereas ProGRP seldom showed a "false positive" test result. ProGRP proved a very high specificity and good sensitivity for small cell lung carcinomas and therefore enables diagnosis of small cell lung carcinoma in patients with lung tumours of unknown origin as well as good control of efficiency of therapy.

CYFRA 21-1 in the early diagnosis of recurrent disease in non small cell lung carcinomas (NSCLC).

UNLABELLED: Due to its high specificity and sensitivity CYFRA 21-1 was found to be the leading marker in NSCLC. We focused our interest on the diagnostic value of CYFRA 21-1 in the detection of recurrent disease of 86 patients suffering from NSCLC following R0-resection (median follow up: 22.7 months). Preoperatively, CYFRA 21-1 was positive (cut off 3.3 ng/mL) in 38 of the 86 patients (45%). 48 hours after surgery all 38 patients had CYFRA 21-1-concentrations within the reference range corresponding to a R0-resection. During further follow up 22 of these patients developed local recurrence and/or distant metastases. All 22 patients showed elevated CYFRA 21-1-values at time of detection of relapse, in 8 patients the CYFRA 21-1-increase preceded the detection of recurrence by 2 to 15 months. 16 patients remained disease free and had stable low CYFRA 21-1-values all the time. Out of the 48 preoperatively CYFRA 21-1-negative patients 15 developed recurrent disease. 7 of the 15 patients proved to express cytokeratin 19-fragments at this time. CONCLUSION: CYFRA 21-1 possesses a high specificity and sensitivity in the detection of recurrent disease of patients suffering from NSCLC and with elevated values at time of primary diagnosis. Thus CYFRA 21-1 could contribute to an economical follow up care. Even if there is not the possibility of curative therapy at time of relapse the early use of systemic therapy could be considered.

[Distribution pattern and involvement of regional lymph nodes in non-small-cell bronchial carcinoma]. / Verteilungsmuster und Befall regionärer Lymphknoten bei nicht-kleinzelligem Bronchialcarcinom.

Despite the important role of lymph node infiltration for the classification and prognosis of non-small-cell lung cancer (NSCLC), no standards exist to evaluate the quality of mediastinal lymphadenectomy. Researches at several centers are not convinced that complete ipsilateral lymphadenectomy is necessary. We investigated 270 consecutive patients undergoing a potential curative operation for NSCLC including complete ipsilateral lymph node dissection in order to ascertain whether or not there is a correlation between tumor localization and lymph node infiltration. Patients were classified into the UICC (1987) stages I (n = 115), II (n = 42), and IIIa (n = 113). In patients with N1-positive lymph nodes (n = 61) we found higher 5-year survival for patients with only intrapulmonary lymph node infiltration (39%) than for patients with hilar infiltration (21%). Patients with N2 disease showed skip metastases in up to 81% of cases. We found that no tumor location predicted the lymph node infiltration. Due to the variability of lymph node infiltration and the frequently occurring skip metastases, complete ipsilateral lymphadenectomy should be the standard for curative operations for NSCLC.