HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard J. Battafarano Bryan F. Meyers Jennifer Bell Zoole G. Alexander Patterson Permission Requests Google Scholar Articles by Veeramachaneni, N. K. Articles by Patterson, G. A. PubMed Articles by Veeramachaneni, N. K. Articles by Patterson, G. A. Related Collections Lung - cancer

Risk factors for occult nodal metastasis in clinical T1N0 lung cancer: a negative impact on survival

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, United States
^b Division of Thoracic Surgery, University of Maryland, Baltimore, MD, United States

Received 29 July 2007; received in revised form 18 November 2007; accepted 10 December 2007.

^_* Corresponding author. Address: 1 Barnes-Jewish Plaza, 3108 Queeny Tower, St. Louis, MO 63110-1013, United States. Tel.: +1 314 362 8598; fax: +1 314 362 0328. (Email: meyersb{at}wustl.edu).

Background: The application of CT imaging has increased the identification of patients with clinical T1N0 (cT1N0) lung cancer. The optimal management strategy for these early stage lung cancers remains unclear. We analyzed the impact of occult nodal metastasis on cT1N0 lung cancer patients. Methods: We studied patients with cT1N0 lung cancer enrolled in our database from January 1995 to December 2002. Preoperative staging was confirmed by review of CT and PET scan studies. Pathology specimens were reviewed. Multivariate analysis was performed to determine the risk of occult nodal involvement. Kaplan–Meier method was applied to analyze survival. Results: Two hundred and ninety-seven patients with cT1N0 disease were identified. Fifty-eight percent of patients were pathological T1N0. Overall, 15% of patients had occult nodal metastasis. Logistic regression analysis demonstrated a three-fold increase in the risk of having pathologic stage II or stage III disease with every 1.0 cm increase in tumor size (odds ratio 3.2; 95% CI: 2.3–4.6). Multivariate analysis demonstrated tumor size to be a significant predictor of nodal metastasis (adjusted odds ratio 3.5; 95% CI: 2.4–5.1). Median survival was different between pathological stage I (96.3 months), stage II (41.4 months), and stage III (36.1 months) disease (p = 0.002). Conclusion: Clinical T1N0 tumors are often understaged. The risk of occult nodal disease increases with tumor size, and this occult disease negatively impacts survival. Because of the limitations of clinical staging, we believe that lobectomy and lymph node analysis should be offered to cT1N0 lung cancer patients to provide accurate staging and to optimize multimodality adjuvant treatment of lung cancer.

Key Words: Lung cancer • Occult nodal metastasis • Lung cancer survival • Lung cancer resection