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J Thorac Cardiovasc Surg 2007;134:386-391
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Intrapulmonary metastasis in resected pathologic stage IIIB non–small cell lung cancer: Possible contribution of aerogenous metastasis to the favorable outcome

^a Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
^b Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
^c Clinical Laboratory Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Received for publication November 8, 2006; revisions received February 5, 2007; accepted for publication February 19, 2007.

^_* Address for reprints: Atsushi Ochiai, MD, PhD, Pathology Division, Research Center for Innovative Oncology, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. (Email: aochiai{at}east.ncc.go.jp).

Objective: Non–small cell lung cancer with pulmonary metastasis in the primary lobe (PM+) is classified as pathologic stage IIIB. Although stage IIIB PM+ indicates a poor prognosis, this stage includes various subgroups with heterogeneous clinical outcomes. The objective of this study was to extract a subgroup of patients with stage IIIB PM+ non–small cell lung cancer with a better prognosis and assess their biological characteristics and metastatic mechanisms.

Methods: We reviewed 122 cases of surgically resected stage IIIB PM+ non–small cell lung cancer and extracted a subgroup with a favorable outcome by univariate analysis of clinicopathologic factors. The 15 cases without lymph node metastasis and vessel invasion (PM+/N–/VI–) were extracted as the most favorable group. We assessed the clinicopathologic features of the PM+/N–/VI– group in comparison with the other patients with stage IIIB PM+ disease.

Results: The disease-specific survival of the PM+/N–/VI– group was significantly better than that of the other stage IIIB PM+ group. Microscopic characteristics of the metastatic lesions suggesting that the cancer cells had invaded via the aerogenous route were seen in 86.7% of the PM+/N–/VI– group, as opposed to only 9.4% of the other PM+ cases. Furthermore, in all 4 patients in the PM+/N–/VI– group who had a recurrence, the relapse involved intrapulmonary metastasis, rather than distant organ metastasis.

Conclusions: Stage IIIB PM+ cases via the airway route were enriched in the PM+/N–/VI– group and had an extremely good survival. This group should be recognized as having local disease, and if relapse occurs in the remnant lobe, it may be possible to achieve a cure by local therapy.

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