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J Thorac Cardiovasc Surg 2008;135:44-49
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Pathologic stage I non–small cell lung cancer with high levels of preoperative serum carcinoembryonic antigen: Clinicopathologic characteristics and prognosis

Haruhisa Matsuguma, MDa,*, Rie Nakahara, MDa, Seiji Igarashi, MDb, Yoshinori Ishikawa, MDa,d, Haruko Suzuki, MDa,d, Naoto Miyazawa, MDa, Satoshi Honjo, MDc,e, Kohei Yokoi, MDa,d

a Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
b Division of Pathology, Tochigi Cancer Center, Utsunomiya, Japan
c Division of Epidemiology, Tochigi Cancer Center, Utsunomiya, Japan
d Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
e Pediatrics Unit, Oomuta National Hospital, National Hospital Organization, Oomuta, Japan.

Received for publication April 16, 2007; revisions received August 24, 2007; accepted for publication September 11, 2007.

* Address for reprints: Haruhisa Matsuguma, MD, Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi 320-0834, Japan. (Email: hmatsugu{at}tcc.pref.tochigi.jp).

Objective: Surgery alone remains the standard therapy for patients with stage I non–small cell lung cancer. Although the preoperative serum level of carcinoembryonic antigen has been shown to be an independent prognostic factor, it has not yet been included in the staging system and does not alter the treatment strategy, especially in the selection of patients for adjuvant chemotherapy.

Methods: From 1986 to 2003, preoperative and postoperative serum carcinoembryonic antigen levels were measured in 455 patients with completely resected pathologic stage I non–small cell lung cancer. We compared the clinicopathologic characteristics and outcomes among patients who had preoperative serum carcinoembryonic antigen levels within the normal range (N group, n = 323), patients who had high carcinoembryonic antigen levels before surgery but normal levels after surgery (HN group, n = 112), and patients who had high carcinoembryonic antigen levels before and after surgery (HH group, n = 20).

Results: The significant characteristics of the HN group included the male sex, greater age, smoking, squamous cell histology, T2 status, lymphatic invasion, vascular invasion, and pleural invasion. Adenocarcinomas in patients of the HN group were more likely to be moderately to poorly differentiated. The 5-year survivals in the HN and HH groups were significantly lower (56.2% and 43.1%, respectively) than those in the N group (85.9%). Multivariate analysis revealed that greater age, non-adenocarcinoma histology, pleural invasion, and the carcinoembryonic antigen in the HN and HH groups were independent prognostic factors.

Conclusion: Patients with resected pathologic stage I non–small cell lung cancer and high preoperative serum carcinoembryonic antigen levels are a subgroup with a distinctly poor prognosis who display smoking-related clinicopathologic characteristics.

Abbreviations and Acronyms BVI = blood vessel invasion; CEA = carcinoembryonic antigen; NSCLC = non–small cell lung cancer; VPI = visceral pleural invasion




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