title: Clinically predictive factors of pathologic upstaging in patients with peripherally located clinical stage IA non-small cell lung cancer.
abstract: OBJECTIVE
  Post-surgical pathologic examination often reveals a more advanced state than clinically defined in non-small cell lung cancer (NSCLC), posing the need for careful consideration of a lesser resection. We investigated the predictive factors for the pathologic upstaging in clinical stage IA NSCLC.
  
  
  METHODS
  The clinical features of 253 consecutive patients with peripherally located T1N0M0 NSCLC who underwent complete resection between 1991 and 2004 were investigated in relation to pathologic T- and N-factors.
  
  
  RESULTS
  Of the 253 patients, 46 (18.2%) were upstaged after surgery, due to T-factor in 12 patients, N-factor in 32, M-factor in 2 and both T- and N-factors in 1. Among the clinical parameters, a higher level of serum CEA (p=0.0378) and larger tumor size (p=0.0276) were observed in the upstaged patients. Multivariable analysis revealed that tumor size and positive serum CEA were independently associated with pathologic upstaging. When tumor size was greater than 10mm, patients with positive serum CEA (>2.0 ng/ml) showed a significantly higher incidence of pathologic upstaging (29.2%) than the rest (15.5%, p=0.0461).
  
  
  CONCLUSIONS
  Clinically defined peripheral stage IA NSCLC should be carefully indicated for a lesser resection when positive serum CEA and/or tumors greater than 10mm in size are observed.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yoshino
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Yohena
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Kameyama
authors.forename: Tetsuzo
authors.initials: T
authors.lastname: Tagawa
authors.forename: Daigo
authors.initials: D
authors.lastname: Kawano
authors.forename: Taro
authors.initials: T
authors.lastname: Oba
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koso
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D002272:Carcinoembryonic Antigen