title: Prognostic impact of preoperative tumor marker levels and lymphovascular invasion in pathological stage I adenocarcinoma and squamous cell carcinoma of the lung.
abstract: BACKGROUND
  Some unfavorable prognostic factors for stage I non-small-cell lung cancers have been reported; however, they are not reflected in the current Tumor-Node-Metastasis classification.
  
  
  METHODS
  We retrospectively reviewed 629 patients who underwent complete resection of pathological stage I adenocarcinomas (ADs) or squamous cell carcinomas (SQs) at two institutes between 1996 and 2011. The correlation between clinicopathological characteristics and survival rates was analyzed to identify prognostic factors.
  
  
  RESULTS
  Multivariate analysis indicated that among ADs, high serum carcinoembryonic antigen levels (p = 0.04 for overall survival [OS]; p < 0.01 for recurrence-free survival [RFS]; p = 0.02 for disease-specific survival [DSS]), lymphatic permeation (p < 0.01 for RFS and DSS), and vascular invasion (p < 0.01 for OS and RFS; p = 0.03 for DSS) were independent prognostic factors. Among SQs, high squamous cell carcinoma antigen (SCC) (p < 0.05 for OS), and vascular invasion (p < 0.05 for RFS and DSS) were independently prognostic. We suggest that among completely resected tumors less than or equal to 5 cm without lymph node metastasis, the current stages IA and IB AD with high serum carcinoembryonic antigen levels, lymphatic permeation, or vascular invasion should be upgraded to stage IB and IIA, respectively. The current stage IA SQ with high SCC antigen levels or vascular invasion should be upgraded to stage IB. These reclassifications accurately reflect survival status (p < 0.04 in all comparisons).
  
  
  CONCLUSIONS
  Some important differences in prognostic factors were observed between AD and SQ. High preoperative serum tumor marker levels and lymphovascular invasion should be included as additional criteria in the forthcoming Tumor-Node-Metastasis staging.
authors: *Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan; †Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan; and ‡Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
authors: Tomonari
authors: T
authors: Kinoshita
authors: Takashi
authors: T
authors: Ohtsuka
authors: Masaya
authors: M
authors: Yotsukura
authors: Keisuke
authors: K
authors: Asakura
authors: Taichiro
authors: T
authors: Goto
authors: Ikuo
authors: I
authors: Kamiyama
authors: Sotaro
authors: S
authors: Otake
authors: Atsushi
authors: A
authors: Tajima
authors: Katsura
authors: K
authors: Emoto
authors: Yuichiro
authors: Y
authors: Hayashi
authors: Mitsutomo
authors: M
authors: Kohno
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D014408:Biomarkers, Tumor