The prognostic significance of skip mediastinal lymphatic metastasis in resected non-small cell lung cancer.

European Journal of Cardio-Thoracic Surgery (Impact Factor: 2.67). 04/2002; 21(3):595. DOI: 10.1016/S1010-7940(01)01135-6
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    ABSTRACT: The patient was a 76-year-old woman who underwent left atrial thrombectomy in November 2003 at our hospital. A mass adhered to the non-coronary aortic cusp was found during annual echocardiography, and the patient was admitted to our hospital. Transthoracic echocardiography detected two masses with pendulum-like movement: a 7-mm mass adhered to the non-coronary cusp and a 5-mm mass on the right coronary cusp. Papillary fibroelastoma was diagnosed based on the absence of inflammatory reactions or valvular destruction. Anticoagulant therapy was continued to prevent left atrial thrombus formation. At surgery, a 7-mm mass was adhered to the belly of the non-coronary cusp and a 5-mm pediculate mass was attached to a site near the nodule of Arantius of the right coronary cusp. Movable fibrous connective tissue 4 mm in length was present at two sites near the nodule of Arantius of the left coronary cusp, and these were also excised. All excised specimens, including those considered to be connective tissue, were found to be papillary fibroelastoma on pathological examination. Four papillary fibroelastomas that developed in all the cusps, including two small connective tissue-like morphologies and two sea anemone-like morphologies, indicated the process of papillary fibroelastoma growth and looked like 'a family'.
    Interactive Cardiovascular and Thoracic Surgery 10/2008; 7(6):1134-6. · 1.11 Impact Factor
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    ABSTRACT: To determine the clinical significance of skip metastases (pN2/S) in patients with resected pIIIA/N2 NSCLC. The incidence of pN2/S after mediastinal lymph node dissection (MLD) and sampling (MLS) were compared. From 1997 to 2000, 580 lung resections for NSCLC performed at our department. The 151 patients (26.5%) at stage IIIA/N2 (pN2+) were grouped according to their skip metastases status. Group A included the ordinary pN2 (pN2/O) cases (71%) and group B the pN2/S (29%). Age, gender, type of resection, right or left lesion, histology, tumor lobe predilection, MLD or MLS pathologic results, the level and the number of node stations involved and survival were analyzed. In 44 patients (29%) pN2/S disease was present. Statistical analysis revealed significant difference between pN2/O and pN2/S for the following: (1) pN2/S was more common for right-sided lesions (P=0.007); (2) Squamous carcinoma was the main type of pN2/S (P=0.007) and (3) pN2/S was more frequently detected after MLD than after MLS (P=0.001). Although pN2/S involved more often upper mediastinal lymph nodes (Nos. 2, 3) and one station level (pN2/S: 41 vs. pN2/O: 19.6%, P=0.228) was not found statistically significant. pN2/O was more common after right upper lobectomy and pN2/S after right lower lobectomy. The 3-year survival was more favorable for the pN2/S group (A: 24 vs. B: 36%, P=0.07). (1) MLD was found to be more reliable for pN2/S detection than MLS. (2) The presence of pN2/S proved to be a less aggressive form of lymphatic spread that should be taken into account in the future. (3) Strong correlation between right lower lobe tumors and pN2/S was demonstrated. (4) Different routes of cancer lymphatic spread between pN2/S and pN2/O are suggested.
    European Journal of Cardio-Thoracic Surgery 05/2004; 25(4):502-8. · 2.67 Impact Factor
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    ABSTRACT: Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC. From 1998 to 2011, 279 patients (155 men and 124 women) with c-stage IA NSCLC (230 pN0, 17 pN1, 12 skip N2, 20 non-skip N2) underwent systematic lobectomy (R0 resection) at our institute. We compared preoperative serum concentrations of carcinoembryonic antigen, cytokeratin 19 fragment, sialyl Lewis X (SLX), and pre- and intraoperative clinicopathological features of pN0 and skip N2 patients. Receiver operator characteristic (ROC) curve analysis was performed to distinguish between the two patient groups. The 5-year survival rate of skip N2 patients was 78.6%, higher than that of non-skip N2 patients (44.9%), and not significantly different than that of pN0 (86.7%) or pN1 patients (82.4%). The mean serum SLX concentration in skip N2 patients (28.0 U/ml) was elevated compared to that in pN0 patients (22.9 U/ml). In ROC analysis of SLX, the area under the curve was 0.710, and the optimal cut-off value was 21.4 U/ml (sensitivity, 91.7%; specificity, 51.7%). In multivariate analysis, SLX was an independent predictor of skip N2 in patients with c-stage IA NSCLC (odds ratio, 9.43; p = 0.006). Skip N2 metastasis is common in patients with c-stage IA NSCLC with high serum SLX, and lobectomy with complete dissection of hilar and mediastinal lymph nodes should remain the standard surgical procedure for these cases.
    World Journal of Surgical Oncology 12/2013; 11(1):309. · 1.09 Impact Factor

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