Intrapulmonary metastasis in resected pathologic stage IIIB non–small cell lung cancer: Possible contribution of aerogenous metastasis to the favorable outcome

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 134; no. 2; pp. 386 - 391
• Main Authors: Aokage, Keiju, MD, Ishii, Genichiro, MD, Nagai, Kanji, MD, Kawai, Osamu, MD, Naito, Yoichi, MD, Hasebe, Takahiro, MD, Nishimura, Mitsuyo, MD, Yoshida, Junji, MD, Ochiai, Atsushi, MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.08.2007; AATS/WTSA; Elsevier
• Subjects: Aged; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cardiothoracic Surgery; Chi-Square Distribution; Female; Humans; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis - pathology; Neoplasm Staging; Pneumology; Prognosis; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Tumors of the respiratory system and mediastinum; UICC; NSCLC; pulmonary metastasis; non–small cell lung cancer; International Union Against Cancer; PM; 10; Heart; Lung disease; Prognosis; Respiratory disease; Thorax; Malignant tumor; Metastasis; non-small cell lung carcinoma; Treatment; Surgery; Bronchus disease; Evolution; Non small cell carcinoma
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.02.048

Objective Non–small cell lung cancer with pulmonary metastasis in the primary lobe (PM+) is classified as pathologic stage IIIB. Although stage IIIB PM+ indicates a poor prognosis, this stage includes various subgroups with heterogeneous clinical outcomes. The objective of this study was to extract a subgroup of patients with stage IIIB PM+ non–small cell lung cancer with a better prognosis and assess their biological characteristics and metastatic mechanisms. Methods We reviewed 122 cases of surgically resected stage IIIB PM+ non–small cell lung cancer and extracted a subgroup with a favorable outcome by univariate analysis of clinicopathologic factors. The 15 cases without lymph node metastasis and vessel invasion (PM+/N−/VI−) were extracted as the most favorable group. We assessed the clinicopathologic features of the PM+/N−/VI− group in comparison with the other patients with stage IIIB PM+ disease. Results The disease-specific survival of the PM+/N−/VI− group was significantly better than that of the other stage IIIB PM+ group. Microscopic characteristics of the metastatic lesions suggesting that the cancer cells had invaded via the aerogenous route were seen in 86.7% of the PM+/N−/VI− group, as opposed to only 9.4% of the other PM+ cases. Furthermore, in all 4 patients in the PM+/N−/VI− group who had a recurrence, the relapse involved intrapulmonary metastasis, rather than distant organ metastasis. Conclusions Stage IIIB PM+ cases via the airway route were enriched in the PM+/N−/VI− group and had an extremely good survival. This group should be recognized as having local disease, and if relapse occurs in the remnant lobe, it may be possible to achieve a cure by local therapy.