title: Lymph node metastasis, recurrence, and prognosis in small peripheral lung adenocarcinoma. Analysis based on replacement.
abstract: OBJECTIVE
  We studied clinical and pathological features of small peripheral adenocarcinoma of the lung, focusing on tumor typing based on Noguchi's classification of small adenocarcinoma and determining whether these tumors grew by replacing alveolar lining cells.
  
  
  METHODS
  Subjects were 51 patients with small peripheral adenocarcinoma 2 cm or less in diameter resected between 1994 and 2001. Mediastinal and hilar lymph node dissection was done in 37 (72.5%). Patients were divided into 2 groups by replacement or nonreplacement tumors. We compared patient profiles, lymph node involvement, and recurrence and survival patterns.
  
  
  RESULTS
  No significant difference was seen between groups in mean age, surgical procedure, or primary tumor location. Women predominated in replacement tumors at 71% vs 41%, p = 0.04. The incidence of lymph node metastasis at 40% vs 4.5%, p = 0.007 and distant metastasis at 47% vs 2.9%, p < 0.001 was significantly higher in nonreplacement than replacement tumors. Replacements tumor thus showed significantly better disease-free survival at 95% vs 53%, p < 0.001, and overall 3-year survival at 95.4% vs 62.7% than did nonreplacement tumors.
  
  
  CONCLUSIONS
  We found distant metastasis and lymph node involvement to be more frequent in nonreplacement than replacement small peripheral adenocarcinoma, on suggesting that pretreatment tumor typing and accurate nodal status determination are essential to improve disease staging.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Sakuragi
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Sakao
authors.forename: Hiroya
authors.initials: H
authors.lastname: Fujita
authors.forename: Masafumi
authors.initials: M
authors.lastname: Natsuaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Itoh
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate