title: Immunohistochemistry-detected microscopic tumor spread affects outcome in en-bloc resection for T3-chest wall lung cancer.
abstract: OBJECTIVE
  This study is aimed at analyzing the effect of immunohistochemistry-detected microscopic tumor spread on long-term survival after en-bloc lung and chest wall resection for T3-chest wall non-small cell lung cancer (NSCLC).
  
  
  METHODS
  We retrospectively reviewed 47 patients (mean age 64.4+/-7.1 years, range 48-77) who underwent radical en-bloc lung and chest wall resection for NSCLC between 1987 and 2000. Resection margins, invasion depth, and lymph nodes were re-assessed by immunohistochemistry with AE1/AE3 anti-cytokeratin and anti-CEA monoclonal antibodies.
  
  
  RESULTS
  Operative mortality and morbidity were 2.1% and 34%, respectively. At immunohistochemistry analysis, five patients (10.6%) revealed microinfiltration of the resection margins that was significantly correlated with the development of local recurrence (p<0.005). Nodal micrometastases were found in 4 out of 33 N0 patients (12.1%), and correlated with distant relapse (p<0.001). Overall and disease-free survivals were significantly influenced by N-status (p<0.001), especially after re-evaluation of micrometastases (p<0.0001), and resection margins microinfiltration (p<0.0001) being these last two the only significant prognostic factors at Cox regression analysis. Five-year overall survival in radically resected patients was 73%.
  
  
  CONCLUSIONS
  In this study immunohistochemical analysis allowed to identify patients at higher risk of recurrence following en-bloc resection for T3-chest wall NSCLC.
authors.affiliation: Thoracic Surgery Division, Tor Vergata University School of Medicine, Policlinico Tor Vergata University, Via Oxford 81, 00133 Rome, Italy.
authors.forename: Tommaso C
authors.initials: TC
authors.lastname: Mineo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ambrogi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Baldi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D035441:Thoracic Wall / Q000473:pathology* / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome