title: A combination of molecular markers accurately detects lymph node metastasis in non-small cell lung cancer patients.
abstract: Occult lymph node metastasis (micrometastasis) is a good prognostic indicator in non-small cell lung cancer (NSCLC) and could be used to direct adjuvant chemotherapy in stage I patients. This study was designed to evaluate molecular markers for detection of occult lymph node metastasis in NSCLC, define the best marker or marker combination to distinguish positive from benign lymph nodes, and evaluate these markers in lymph nodes from pathologically node-negative (pN(0)) NSCLC patients. Potential markers were identified through literature and database searches and all markers were analyzed by quantitative reverse transcription-PCR in a primary screen of six NSCLC specimens and 10 benign nodes. Selected markers were further evaluated on 21 primary NSCLC specimens, 21 positive nodes, and 21 benign nodes, and the best individual markers and combinations were identified. A combination of three markers was further validated on an independent set of 32 benign lymph nodes, 38 histologically positive lymph nodes, and 462 lymph nodes from 68 pN(0) NSCLC patients. Forty-two markers were evaluated in the primary screen and eight promising markers were selected for further analysis. A combination of three markers (SFTPB, TACSTD1, and PVA) was identified that provided perfect classification of benign and positive nodes in all sample sets. PVA and SFTPB are particularly powerful in tumors of squamous and adenocarcinoma histologies, respectively, whereas TACSTD1 is a good general marker for NSCLC metastasis. The combination of these genes identified 32 of 462 (7%) lymph nodes from 20 of 68 (29%) patients as potentially positive for occult metastasis. Long-term follow-up will determine the clinical relevance of these findings.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Liqiang
authors.initials: L
authors.lastname: Xi
authors.forename: Michael C
authors.initials: MC
authors.lastname: Coello
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Litle
authors.forename: Siva
authors.initials: S
authors.lastname: Raja
authors.forename: William E
authors.initials: WE
authors.lastname: Gooding
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Yousem
authors.forename: Talal
authors.initials: T
authors.lastname: El-Hefnawy
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Tony E
authors.initials: TE
authors.lastname: Godfrey
mesh_terms: D000951:Antigens, Neoplasm / Q000235:genetics; D014408:Biomarkers, Tumor / Q000235:genetics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics / Q000473:pathology*; D015815:Cell Adhesion Molecules / Q000235:genetics; D051184:Desmoglein 3 / Q000235:genetics; D000071858:Epithelial Cell Adhesion Molecule; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology*; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000235:genetics; D037701:Pulmonary Surfactant-Associated Protein B / Q000235:genetics; D015203:Reproducibility of Results; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D015815:Cell Adhesion Molecules; C071894:DSG3 protein, human; D051184:Desmoglein 3; C499379:EPCAM protein, human; D000071858:Epithelial Cell Adhesion Molecule; D037701:Pulmonary Surfactant-Associated Protein B