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J Thorac Cardiovasc Surg 2006;131:988-993
© 2006 The American Association for Thoracic Surgery
General Thoracic Surgery |
Division of General Thoracic Surgery, Department of Surgery (E1), Osaka University Graduate School of Medicine, Osaka, Japan
Received for publication October 12, 2005; revisions received December 11, 2005; accepted for publication December 16, 2005. * Address for reprints: Masayoshi Inoue, MD, PhD, 2-2 Yamadaoka Suita-city, Osaka 565-0871, Japan (Email: masa{at}surg1.med.osaka-u.ac.jp).
OBJECTIVE: The number of surgical interventions for small-sized lung cancer has increased with the development of computed tomography. We attempted to identify clinicopathologic characteristics of peripheral, small-sized, nonsmall cell lung cancer to show the limitation of partial resection or segmentectomy.
METHODS: A retrospective analysis of 143 patients who underwent a complete resection for a peripheral nonsmall cell lung cancer of 2 cm or less in diameter was performed. The relationships between nodal involvement and other clinical factors were also assessed in patients who underwent a lobectomy plus node dissection.
RESULTS: The overall 5-year survival rate was 88.1%. The 5-year survival rate was 100% for patients with a tumor of 1.5 cm or less. Survival for patients with adenocarcinoma histology was significantly better than for those with nonadenocarcinoma histology (P = .03). The 5-year survival rate for patients without lymph node metastases was 91.6%, whereas it was 62.5% for those with nodal involvement (P < .01). Increase of prethoracotomy serum carcinoembryonic antigen level was an independent predictor of a poor prognosis. Lymph node metastasis was significantly increased in those with pleural invasion by the primary lesion and increased serum carcinoembryonic antigen level. Fourteen (16.9%) of 83 patients with a tumor diameter of larger than 1.5 cm had nodal metastasis.
CONCLUSIONS: Nodal involvement should be considered in patients with nonsmall cell lung cancer of 2 cm or less in diameter who show pleural invasion or an increased carcinoembryonic antigen level. A lobectomy with node dissection is recommended for patients with a tumor larger than 1.5 cm, suspected pleural invasion, or prethoracotomy carcinoembryonic antigen level increase.
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