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J Thorac Cardiovasc Surg 2006;131:988-993
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Clinicopathologic study of resected, peripheral, small-sized, non–small cell lung cancer tumors of 2 cm or less in diameter: Pleural invasion and increase of serum carcinoembryonic antigen level as predictors of nodal involvement

Masayoshi Inoue, MD * , Masato Minami, MD, Hiroyuki Shiono, MD, Noriyoshi Sawabata, MD, Kan Ideguchi, MD, Meinoshin Okumura, MD

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, non–small 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 non–small 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 non–small 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.

Abbreviations and Acronyms BAC = bronchioloalveolar carcinoma; CEA = carcinoembryonic antigen; CT = computed tomography; GGO = ground-glass opacity




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