Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
Hum Pathol. 2010 Nov;41(11):1536-43. doi: 10.1016/j.humpath.2010.04.006. Epub 2010 Jul 24.
The prognostic role of small intrathoracic nodal metastases in primary patients with lung cancer has been controversial, and it is unclear how their presence should be used for pathologic staging and treatment planning. The intrathoracic lymph nodes from 266 clinical stage I non-small cell carcinoma patients treated at Cedars Sinai Medical Center from 1992 to 2006 were evaluated with immunohistochemistry for keratin AE1/AE3 for the presence of isolated tumor cells and micrometastases, as defined by American Joint Commission on Cancer criteria, correlated with survival using the Kaplan-Meier method and analyzed with power analysis. The English literature from 1995 to 2008 was reviewed to identify best available evidence regarding the prognostic value of isolated tumor cells and micrometastases detected with various immunohistochemistry and molecular methods in non-small cell carcinoma patients. Results were combined with our own data and evaluated with meta-analysis using Comprehensive Meta-analysis 2.0 software (Biostat Inc, Englewood, NJ). Isolated tumor cells and micrometastases were detected in 8 and 67 of 4148 lymph nodes, respectively, and their presence was not significantly associated with survival. Power analysis showed that 3060 cases followed up for 60 months would be needed to achieve 80% power in a study designed to detect survival differences between patients with negative nodes and micrometastases. Meta-analysis of 835 non-small cell carcinoma patients reported in 13 studies showed scanty data to evaluate patients with isolated tumor cells, no significant association between micrometastases and survival and significant data heterogeneity. Current best evidence suggests that non-small cell carcinoma patients should probably not be "upstaged" in the presence of isolated tumor cells and micrometastases. There is no data demonstrating survival benefits for patients treated with adjuvant chemotherapy and/or radiation therapy because of the presence of small nodal metastases.
在原发性肺癌患者中，小的胸内淋巴结转移的预后作用一直存在争议，目前尚不清楚如何将其存在用于病理分期和治疗计划。本研究评估了 1992 年至 2006 年期间在 Cedars Sinai 医疗中心接受治疗的 266 例临床 I 期非小细胞肺癌患者的胸内淋巴结，使用免疫组织化学方法检测角蛋白 AE1/AE3 以确定是否存在孤立肿瘤细胞和微转移，其定义符合美国癌症联合委员会标准，通过 Kaplan-Meier 方法进行生存相关性分析，并进行功效分析。对 1995 年至 2008 年的英文文献进行了回顾，以确定在非小细胞肺癌患者中使用各种免疫组织化学和分子方法检测孤立肿瘤细胞和微转移的最佳可用证据的预后价值。将结果与我们自己的数据相结合，并使用 Comprehensive Meta-analysis 2.0 软件（Biostat Inc，Englewood，NJ）进行荟萃分析。在 4148 个淋巴结中，分别检测到 8 个和 67 个淋巴结存在孤立肿瘤细胞和微转移，但其存在与生存无显著相关性。功效分析表明，在一项设计用于检测阴性淋巴结和微转移患者生存差异的研究中，需要 3060 例随访 60 个月才能达到 80%的功效。对 13 项研究中报道的 835 例非小细胞肺癌患者的荟萃分析显示，数据稀少，难以评估孤立肿瘤细胞患者，微转移与生存之间无显著关联，且数据异质性显著。目前的最佳证据表明，在存在孤立肿瘤细胞和微转移的情况下，非小细胞肺癌患者可能不应该“升级”分期。尚无数据表明，由于存在小的淋巴结转移，接受辅助化疗和/或放疗的患者有生存获益。
