The impact of immunohistochemical detection of positive lymph nodes in early stage lung cancer.
BACKGROUND
Detection of micrometastatic disease is an interesting area in non-small cell lung cancer (NSCLC). We conducted a study to determine whether the detection of mediastinal lymph node spread by immunohistochemical (IHC) analysis offers some prognosis with respect to patients' disease-free survival or not.


METHODS
Between 1997 and 2003, twenty-one early stage lung cancer patients underwent complete resection with mediastinoscopy and systemic nodal dissection. Four hundred and twenty-six paraffin-embedded lymph node sections from 21 patients were analyzed. Epithelial specific-antigen Ab-9 and Keratin-Pan Ab-1 were used as IHC marker.


RESULTS
Based on nodal spread four of the 21 patients (19.04%) were up-staged after IHC analysis. Two patients with stage IB (T2N0) up-staged to stage IIIA (T2N2); two patients staged as IIB (T2N1) up-staged to IIIA (T2N2). Statistical analysis showed that the lymphatic dissemination detected with IHC analysis was associated with reduced disease-free survival (DFS) (p = 0.002).


CONCLUSIONS
Our study provides some indication that patients with lymphatic micrometastasis have a reduced DFS. Before creating a new TNM staging system, more information is needed to understand the prognostic impact of micrometastatic dissemination.
Department of Thoracic Surgery, Heybeliada Chest Disease and Thoracic Surgery Center, Istanbul, Turkey. mdcagatay@hotmail.com
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Tezel
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Ersev
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Kiral
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Urek
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Kosar
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Keles
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Dudu
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Arman
D000912:Antibodies, Neoplasm / Q000276:immunology; D014408:Biomarkers, Tumor / Q000276:immunology / Q000378:metabolism*; D002277:Carcinoma / Q000378:metabolism / Q000473:pathology / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000276:immunology / Q000378:metabolism*; D008175:Lung Neoplasms / Q000378:metabolism / Q000473:pathology*; D008198:Lymph Nodes / Q000378:metabolism* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D000951:Antigens, Neoplasm
D000912:Antibodies, Neoplasm; D014408:Biomarkers, Tumor; D007633:Keratins; C115012:human epithelial antigen-125; D000951:Antigens, Neoplasm