title: Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer.
abstract: BACKGROUND
  Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC.
  
  
  METHODS
  From 1998 to 2011, 279 patients (155 men and 124 women) with c-stage IA NSCLC (230 pN0, 17 pN1, 12 skip N2, 20 non-skip N2) underwent systematic lobectomy (R0 resection) at our institute. We compared preoperative serum concentrations of carcinoembryonic antigen, cytokeratin 19 fragment, sialyl Lewis X (SLX), and pre- and intraoperative clinicopathological features of pN0 and skip N2 patients. Receiver operator characteristic (ROC) curve analysis was performed to distinguish between the two patient groups.
  
  
  RESULTS
  The 5-year survival rate of skip N2 patients was 78.6%, higher than that of non-skip N2 patients (44.9%), and not significantly different than that of pN0 (86.7%) or pN1 patients (82.4%). The mean serum SLX concentration in skip N2 patients (28.0 U/ml) was elevated compared to that in pN0 patients (22.9 U/ml). In ROC analysis of SLX, the area under the curve was 0.710, and the optimal cut-off value was 21.4 U/ml (sensitivity, 91.7%; specificity, 51.7%). In multivariate analysis, SLX was an independent predictor of skip N2 in patients with c-stage IA NSCLC (odds ratio, 9.43; p = 0.006).
  
  
  CONCLUSIONS
  Skip N2 metastasis is common in patients with c-stage IA NSCLC with high serum SLX, and lobectomy with complete dissection of hilar and mediastinal lymph nodes should remain the standard surgical procedure for these cases.
authors: Hiroaki
authors: H
authors: Komatsu
authors: Shinjiro
authors: S
authors: Mizuguchi
authors: Nobuhiro
authors: N
authors: Izumi
authors: Kyukwang
authors: K
authors: Chung
authors: Shoji
authors: S
authors: Hanada
authors: Hidetoshi
authors: H
authors: Inoue
authors: Shigefumi
authors: S
authors: Suehiro
authors: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. m1364552@msic.med.osaka-cu.ac.jp.
authors: Noritoshi
authors: N
authors: Nishiyama
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053539:Keratin-19 / Q000378:metabolism; D008175:Lung Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009844:Oligosaccharides / Q000378:metabolism*; D011379:Prognosis; D000080506:Sialyl Lewis X Antigen; D015996:Survival Rate
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D053539:Keratin-19; D009844:Oligosaccharides; D000080506:Sialyl Lewis X Antigen; C102012:antigen CYFRA21.1