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Eur J Cardiothorac Surg 2007;31:1120-1124. doi:10.1016/j.ejcts.2007.02.021
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Immunohistochemistry-detected microscopic tumor spread affects outcome in en-bloc resection for T3-chest wall lung cancer

^a Thoracic Surgery Division, Tor Vergata University School of Medicine, PoliclinicoTor Vergata University, Rome, Italy
^b Department of Biochemistry and Biophysic "F. Cedrangolo", Section of Anatomic Pathology, Second University of Naples, Naples, Italy

Received 28 November 2006; received in revised form 15 February 2007; accepted 20 February 2007.

^_* Corresponding author. Address: Cattedra di Chirurgia Toracica, Università Tor Vergata, Policlinico Tor Vergata, Via Oxford, 81, 00133 Rome, Italy. Tel.: +39 06 20902884; fax: +39 06 20902881. (Email: pompeo{at}med.uniroma2.it).

Objective: This study is aimed at analyzing the effect of immunohistochemistry-detected microscopic tumor spread on long-term survival after en-bloc lung and chest wall resection for T3-chest wall non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed 47 patients (mean age 64.4 ± 7.1 years, range 48–77) who underwent radical en-bloc lung and chest wall resection for NSCLC between 1987 and 2000. Resection margins, invasion depth, and lymph nodes were re-assessed by immunohistochemistry with AE1/AE3 anti-cytokeratin and anti-CEA monoclonal antibodies. Results: Operative mortality and morbidity were 2.1% and 34%, respectively. At immunohistochemistry analysis, five patients (10.6%) revealed microinfiltration of the resection margins that was significantly correlated with the development of local recurrence (p < 0.005). Nodal micrometastases were found in 4 out of 33 N0 patients (12.1%), and correlated with distant relapse (p < 0.001). Overall and disease-free survivals were significantly influenced by N-status (p < 0.001), especially after re-evaluation of micrometastases (p < 0.0001), and resection margins microinfiltration (p < 0.0001) being these last two the only significant prognostic factors at Cox regression analysis. Five-year overall survival in radically resected patients was 73%. Conclusions: In this study immunohistochemical analysis allowed to identify patients at higher risk of recurrence following en-bloc resection for T3-chest wall NSCLC.

Key Words: NSCLC • Chest wall invasion • Surgery • Immunohistochemistry • Prognostic factors • Survival

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