Predictive Factors of Lymph Node Status in Small Peripheral Non-small Cell Lung Cancers: Tumor Histology is Better Than Subcentimeter in Size

Lung cancer staging is a process used to assess the extent of spread of lung cancer, determine the most appropriate treatment and predict the patient’s prognosis. Clinical staging is performed prior to surgical resection, while surgical-pathologic staging is based on histologic analysis of the resected tumor and lymph nodes. Restaging is performed following treatment. Staging is based on the TNM classification system. T refers to the primary tumor, N to thoracic lymph node involvement and M to metastatic disease. Recent changes to T and M descriptors were made to better reflect actual survival. For the majority of non-small cell lung cancers, the presence or absence of mediastinal lymph node spread is the most important outcome predictor. Although no changes were made to the N descriptor, the actual intrathoracic lymph node stations were recently clarified. Although the majority of small cell lung cancers are metastatic at the time of presentation, the presence of limited versus extensive spread of disease determines treatment options. However, the overall prognosis and survival for affected patients is poor. TNM staging is now recommended for carcinoid tumors as well as small cell lung cancer.

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Novel staging protocol for non-small-cell lung cancers according to MRP-1/CD9 and KAI1/CD82 gene expression.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.4.1397 ◽

1998 ◽

Vol 16 (4) ◽

pp. 1397-1406 ◽

Cited By ~ 43

Author(s):

M Adachi ◽

T Taki ◽

T Konishi ◽

C I Huang ◽

M Higashiyama ◽

...

Keyword(s):

Small Cell ◽

Nodal Status ◽

Pcr Analysis ◽

Significant Prognostic Factor ◽

Small Cell Lung ◽

New Classification ◽

Lung Cancers ◽

Group A ◽

Group B ◽

Better Than

PURPOSE The transmembrane-4 superfamily (TM4SF) is a recently discovered family of genes. Of the TM4SF members, MRP-1/CD9, KAI1/CD82, and ME491/CD63 have been reported to modulate tumor progression or metastasis. In this study, we investigated the relationships between these three genes, MRP-1, KAI1, and ME491, in patients with non-small-cell lung cancers (NSCLCs). Moreover, we assessed the prognostic value of evaluating the expressions of MRP-1, KAI1, and ME491 simultaneously in NSCLCs. PATIENTS AND METHODS One hundred seventy-two patients up to stage IIIB NSCLC underwent radical surgery during the period of January 1991 through June 1994. Using a quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) analysis, we studied the expression of MRP-1, KAI1, and ME491 genes in these patients. RESULTS We found that 109 patients (63.4%) had MRP-1-positive tumors and 42 patients (24.4%) had KAl1-positive tumors. Conversely, all 172 patients expressed ME491. No relationship was found between MRP-1 expression and KAI1 expression. We classified these patients into three groups. The 36 patients who were positive for both MRP-1 and KAI1 were defined as group A; the 79 patients with reduced expression of either MRP-1 or KAI1 were defined as group B, and the remaining 57 patients with reduced expression of both MRP-1 and KAI1 were defined as group C. This new classification was correlated with nodal status, tumor status, and pathologic stage (P = .0056, P = .0003, and P < .0001, respectively). In NSCLC patients, the 5-year survival rate of group A patients was significantly better than that of group B patients and much better than that of group C patients (86.8%, 53.9%, and 31.5%, respectively; P < .0001). Cox multivariate regression analysis showed that this new classification in NSCLCs was a significant prognostic factor, as was the nodal status (P < .0001). CONCLUSION Our results suggest that a low MRP-1 and KAI1 expression by tumors of the lung may be associated with poor prognosis. It is conceivable that the evaluation for MRP-1 and KAI1 expression may identify node-negative lung cancer patients who are at high risk for early disease recurrence, and thus need intensive adjuvant therapy.

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