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J Thorac Cardiovasc Surg 1995;110:286
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Sites of first distant recurrence in resected non-small-cell lung cancer

Division of Thoracic Surgery
Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263-0001

To the Editor:

I read with interest the article by Yano and associates. ¹ The authors hypothesize that the venous drainage of mediastinal lymph nodes is to the superior vena cava and that this may increase the likelihood of pulmonary metastasis in patients with N2 lung cancer. This proposed mechanism of metastatic spread is not present in patients with N0 lung cancer; therefore a different pattern of distant failure is anticipated in such patients. The hypothesis is fascinating, but the authors' data are insufficient to justify its acceptance.

The lung was the first site of distant recurrence in 10 of 52 patients with N0 disease and 12 of 40 with N2 disease. Although my knowledge of statistics is limited, a simple ² test to compare the frequency of lung metastasis in the two groups would appear to be appropriate. This test gives a p value of 0.23 ( ² = 1.44). The authors state that the overall pattern of distant metastasis was different between patients with N0 disease and those with N2 disease (p = 0.044). Although their statement is undoubtedly true, the difference is probably a reflection of the higher incidence of brain metastasis in the N0 group (p < 0.013, ² = 6.14). A significant difference in the prevalence of brain metastasis does not necessarily support the authors' hypothesis of pulmonary metastatic spread from mediastinal lymph nodes.

References

1. Yano T, Yokoyama H, Inoue T, et al. The first site of recurrence after complete resection in non-small-cell carcinoma of the lung: comparison between pN0 disease and pN2 disease. J THORAC CARDIOVASC SURG 1994;108:680-3.[Abstract/Free Full Text]
   

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This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John D. Urschel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Urschel, J. D. Search for Related Content PubMed PubMed Citation Articles by Urschel, J. D.