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KMID : 0982820040030020071
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Journal of Lung Cancer
2004 Volume.3 No. 2 p.71 ~ p.76
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Analysis for Prognostic Factors of Postoperative Stage I Non-small Cell Lung Cancer
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Park Chang-Kwon
Park Hoon
Keum Dong-Yoon
Kang Yu-Na
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Abstract
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Objective: This study is to evaluate several histopathologic variables and molecular markers in patients with stage I NSCLC after complete tumor resection to assess their prognostic value.
Materials and Methods: Ninety one patients with stage I NSCLC, SCC or adenocarcinoma histologically, operated between March 1992 and December 2003 were evaluated. The postoperative 5-year survival rate was calculated with the Kaplan-Meier method. Comparison of the risk factors for recurrence was performed by ?2 test. Multivariate analyses were performed using Cox proportional hazards model to identify independent prognostic factors. The criterion for significance was p＜0.05.
Results: There were 73 men (80.2%) and 18 women (19.8%) a mean?SD age at diagnosis of 61.9?8.5 years (range, to years). A pulmonary resection and mediastinal lymph node dissection were done in all cases. A lobectomy was performed in 78 cases (93.4%, included with bilobectomy, 10 and sleeve lobectomy, 7) and a pneumonectomy in 6 cases (6.6%). The histologic types were SCC in 57 cases (62.6%) and adenocarcinoma in 34 cases (37.4%). There was no operative mortality and complications occured in 2 cases (1.1%). The overall 5-year survival was 59.8% and survival time did not depend on the type of operation or histologic type. Significant predictors of recurrence were stage Ib and worse differentation than moderate (p=0.003 and 0.037 each). The overall incidence of recurrence was 38.5% (local or regional 37%, distant 63%). Almost all recurrences (35 cases) occurred in T2 lesions. The distant organs that failed were , the brain in 8 patients, the liver in 6, the multiple lung metastasis in 5, the bone in 2, and extrapulmonary node in 1. We found significant differences between SCC and adenocarcinoma in sex predominence (p=0.001) and visceral pleural invasion (p=0.035). In immunohistochemical stain, the SCC showed higher CD44 expression (p=0.023) than adenocarcinoma and TTF-1 higher expression (p＜0.05) on adenocarcinoma than SCC. Multivariate analysis showed that CD44 less expression than 10% (p=0.039) were significant independent prognostic factors of survival on patients with adenocarcinoma.
Conclusions: We found that T2 lesion and poorly differentiated/undifferentiated tumor had significant value to predict the risk of recurrence. We suggest that CD44 antibody could be used as a prognostic value in patients of resected stage I non small cell lun cancer.
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KEYWORD
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Histopathologic variables, Molecular markers, Non-small cell lung cancer, Prognostic value, Risk factors of recurrence
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