Does the lobectomy plus lymph node dissection still remain a standard surgical procedure for patients with cT1N0M0 adenocarcinoma of the lung? |
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Authors: | Arifumi Iwamaru Tai Hato Yoshitaka Kashima Masashi Kobayashi Toshinori Hashizume Etsuo Nemoto Yoshihiro Nishimura Yukio Morishita and Shimao Fukai |
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Institution: | (1) Department of Pathology, National Seiran-sou Hospital, Toukai, Ibaraki, Japan;(2) Department of Surgery, National Seiran-sou Hospital, 825 Terunuma, Toukai, 319-1113 Ibaraki, Japan |
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Abstract: | Objectives: Controversies still exists regarding treatment for cT1N0M0 adenocarcinoma of the lung. The following topics need to be answered:
1) Should all patients undergo lobectomy plus lymph node dissection? and 2) Is there poor-prognostic subgroup that may need
adjuvant therapy? Methods: Between 1990 and 1999,141 patients with cT1N0M0 adenocarcinoma of the lung underwent lobectomy plus lymph node dissection.
Fifteen clinicopathological characteristics of the entire population were investigated with regard to survival. Forty-seven
samples, which were possible to reexamine among 68 patients with small adenocarcinoma 2 cm or less in greatest dimension,
were assessed according to Noguchi’s classification. Results: Nine of fifteen clinicopathological variables were significant in indicating poor prognostic factors in univariate analysis:
gender, differentiation, p-T status, p-N status, pm, lymphatic invasion, vascular invasion, pleural invasion, and serum carcinoembryonic
antigen (CEA) level. The p-N status and high serum CEA level were independent predictive variables in multivariate analysis.
A five-year survival rate for patients with Noguchi’s type A and B was 100%. However, six (8.8%) of 68 patients with small
adenocarcinoma had lymph node involvement and four patients (5.9%) had pulmonary metastasis. Conclusions: It is inappropriate and inadequate to omit lobectomy or lymph node dissection only on the basis of tumor size. Therefore,
it seems reasonable to conclude that lobectomy plus lymph node dissection still remains as a standard surgical procedure to
treat cT1N0M0 adenocarcinoma of the lung. We must continue to search for new deciding factors in order to choose candidates
for limited operation among patients with cT1N0M0 adenocarcinoma of the lung.
Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Symposium, Tokyo, November 19–21,
2003. |
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Keywords: | cT1N0M0 adenocarcinoma of the lung Noguchi’ s classification standard surgical procedure adjuvant therapy |
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