[Immunomorphology of lymph nodes and prognosis in lung cancer].
BACKGROUND
Many studies have investigated locoregional immune responses and long-term survival in various types of cancer; few have focused on lung cancer. This study was designed to assess the prognostic value of immunomorphologic changes in locoregional lymph nodes in patients resected for bronchogenic carcinoma.


METHODS
In a retrospective analysis, immune responses in locoregional lymph nodes were studied histologically in 172 selected patients. Lymph node morphology was studied according to the system of Cottier et al.: sinus histiocytosis (SH) and paracortical lymphoid cell hyperplasia (PCA) were considered as a cellular immune response, and follicular hyperplasia of the cortical area (CA) as a humoral reaction. The survival rate was estimated by the Kaplan-Meier product-limit method. Log-rank test and Cox proportional-hazards model were used to determine statistical significance in univariate and multivariate survival analysis.


RESULTS
35.5% of the patients had no evident response in regional nodes; 19.8% had a marked cellular response; 11% a marked humoral response; and 33.7% a mixed cellular-humoral response. A nodal cellular response improved long-term survival rates even in patients with regional node metastases. Multivariate analysis identified an independent variable as having high prognostic value: lymph node immunoreactivity.


CONCLUSIONS
Lymph node immunoreactivity significantly influences long-term survival after curative surgery for lung cancer and may be useful in stratifying patients for prospective trials of adjuvant treatment including immunotherapy.
Di Giorgio
A
A
Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Rome, Italy.
Sammartino
P
P
Canavese
A
A
Arnone
P
P
Sibio
S
S
Accarpio
F
F
Al Mansour
M
M
D000230:Adenocarcinoma / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D018288:Carcinoma, Small Cell / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D008198:Lymph Nodes / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors