Lymph Node Metastasis from Non-Small Cell Lung Cancer Imaging, Resection, Enhanced Pathologic Detection and Survival Implication

Аннотация

Background: Lymph node staging is a critical prognostic factor in non-small cell lung cancer (NSCLC) patients. Many surgical patients have grossly inadequate lymph node (LN) sampling. A standard of care for lymph node sampling is essential. There are limitations in the ability to accurately identify all lymph node malignant disease in patients even after sufficient numbers of nodes are harvested. This results in understaging of patients. Radioguided selection of the most suspicious lymph nodes in a patient permits the use of advanced pathologic methods to detect micrometastases. Understanding the role of lymphangiogenic factors in the onset of lymphatic metastases may facilitate the application of novel therapies to improve NSCLC survival. Methods: We used the Surveillance, Epidemiology and End Results (SEER) database to perform multivariate cox proportional hazards assessment of the prognostic value of the number of resected LNs and LNR in over 25,000 stages I-III NSCLC patients in the 1988-2007 SEER database. A gamma probe was used in 100 stage I or II patients with resectable lung cancers to detect increased fluorodeoxyglucose (FDG) uptake within thoracic lymph nodes during pulmonary resection procedures. We compared the accuracy of detecting LN metastases using either positron emission tomography- computed tomography (PET-CT) or the gamma probe and quantified the ability of the gamma probe to up-stage patients using IHC and RT-PCR forepithelial markers. We also correlated detection of LN micrometastases with VEGF A, C, D andVEGF-R3 expression. Clinical follow-up to correlate LN micrometastasis with survival isongoing.