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Significance of Extranodal Extension of Regional Lymph Nodes in Surgically-Resected Non-Small Cell Lung Cancer: A Reappraisal for Lymph Node Staging
Y. C. Lee, C. T. Wu, S. W. Kuo, Y. T. Tseng, Y. L. Chang. National Taiwan University Hospital, Taipei, Taiwan Republic of China,
BACKGROUND:
Regional lymph nodes involvement affects the prognosis of patients with surgically resected non-small cell lung cancer (NSCLC). The significance of extranodal extension in these patients was studied to determine its clinicopathological relations and its influence on patient’s survival.
METHODS:
A total of one hundred and ninety nine NSCLC patients who were proved to have regional lymph node involvement after resection. Histological examinations including tumor cell type, grade of differentiation, vascular invasion, regional lymph node metastasis emphasizing on number and station of lymph node involvement, presence or absence of extranodal extension and immunohistochemistry of p53 expression were obtained. The relations of extranodal extension with histological type, grade of differentiation, vascular invasion, tumor size, pathological stage, p53 expression and patient’s survival were analysed.
RESULTS:
The positive rate of extranodal extension was significantly higher in female, adenocarcinoma, advanced stage, tumor with vascular invasion or p53 overexpression. The total number and positive rate of resected lymph node with extranodal extension were significantly correlated with advanced stage, tumor with vascular invasion or p53 overexpression. By multivariate analysis of patient’s survival, the presence, total number of lymph node with extranodal extension, tumor stage and p53 expression were significant prognostic factors. The 5 year survival rate of stage IIIA patients without extranodal extension (30.4%) was significantly better than stage II patients with extranodal extension (16.8%). No survival difference between extranodal positive stage II and IIIA patients was noted.
CONCLUSIONS:
Extranodal extension of regional lymph nodes is an important prognostic factor in surgically resected NSCLC.
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