Marchevsky Alberto M, Qiao Jian-Huan, Krajisnik Sanja, Mirocha James M, McKenna Robert J
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):551-7. doi: 10.1016/s0022-5223(03)00123-5.
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.
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.
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.
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.
研究按照美国癌症联合委员会当前关于肺外肿瘤的标准所定义的孤立肿瘤细胞和微转移灶，对于接受手术切除的非小细胞肺癌患者是否具有预后价值。
对60例非小细胞肺癌患者的1063个胸内淋巴结进行研究，通过连续组织学切片和角蛋白免疫染色来检测转移灶。转移灶分为孤立肿瘤细胞、pN1mi、pN1、pN2mi和pN2。孤立肿瘤细胞小于0.2毫米，而pN1mi和pN2mi的大小为0.2毫米至2毫米。进行生存分析，并按淋巴结状态和分期进行分层。
在33例pN0患者中的5例的11个淋巴结以及9例pN1和pN2患者中检测到了孤立肿瘤细胞。3例患者的淋巴结被重新分类为pN1mi。未检测到pN2mi。基于将队列分为I至III期的分层的生存模型具有显著性（卡方 = 7.426，自由度 = 2，P = 0.024），但I期和II期患者的生存曲线之间存在相当大的重叠。将孤立肿瘤细胞和pN1mi分层为I期疾病的模型具有显著性（卡方 = 7.985，自由度 = 2，P = 0.018），并且I期和II期患者的生存曲线之间没有重叠。pN0、孤立肿瘤细胞和pN1mi的患者之间生存功能没有显著差异。
伴有孤立肿瘤细胞和pN1mi的非小细胞肺癌患者的生存率与pN0患者相似，这与乳腺癌患者的报道结果一致。需要对非小细胞肺癌患者进行未来更大规模的研究，以确认当前美国癌症联合委员会的分期标准是否应修改以纳入pN1mi类别。
