Detection of Occult Micrometastases in Patients With Clinical Stage I Non–Small-Cell Lung Cancer: A Prospective Analysis of Mature Results of CALGB 9761 (Alliance)
Year: 2016
Type: article
Abstract: PURPOSE: Outcomes after resection of stage I non-small-cell lung cancer (NSCLC) are variable, potentially due to undetected occult micrometastases (OM). Cancer and Leukemia Group B 9761 was a prospectively designed study aimed at determining the prognostic significance of OM. MATERIALS AND METHODS: Between 1997 and 2002, 502 patients with suspected clinical stage I (T1-2N0M0) NSCLC were prospectively enrolled at 11 institutions. Primary tumor and lymph nodes (LNs) were collected and sent to a central site for molecular analysis. Both were assayed for OM using immunohistochemistry (IHC) for cytokeratin (AE1/AE3) and real-time reverse transcriptase polymerase chain reaction (RT-PCR) for carcinoembryonic antigen. RESULTS: Four hundred eighty-nine of the 502 enrolled patients underwent complete surgical staging. Three hundred four patients (61%) had pathologic stage I NSCLC (T1, 58%; T2, 42%) and were included in the final analysis. Fifty-six percent had adenocarcinomas, 34% had squamous cell carcinomas, and 10% had another histology. LNs from 298 patients were analyzed by IHC; 41 (14%) were IHC-positive (42% in N1 position, 58% in N2 position). Neither overall survival (OS) nor disease-free survival was associated with IHC positivity; however, patients who had IHC-positive N2 LNs had statistically significantly worse survival rates (hazard ratio, 2.04, P = .017). LNs from 256 patients were analyzed by RT-PCR; 176 (69%) were PCR-positive (52% in N1 position, 48% in N2 position). Neither OS nor disease-free survival was associated with PCR positivity. CONCLUSION: NSCLC tumor markers can be detected in histologically negative LNs by AE1/AE3 IHC and carcinoembryonic antigen RT-PCR. In this prospective, multi-institutional trial, the presence of OM by IHC staining in N2 LNs of patients with NSCLC correlated with decreased OS. The clinical significance of this warrants further investigation.
Source: Journal of Clinical Oncology
Authors: Linda W. Martin, Jonathan D’Cunha, Xiaofei Wang, Debra Herzan, Lin Gu, Naif Abraham, Todd L. Demmy, Frank C. Detterbeck, Shawn S. Groth, David H. Harpole, Mark J. Krasna, Kemp Kernstine, Leslie J. Kohman, G. Alexander Patterson, David J. Sugarbaker, Robin T. Vollmer, Michael A. Maddaus, Robert A. Kratzke
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: National Cancer Institute
Awards: Alliance Statistics and Data Management Center, WUMC Cancer and Leukemia Group B, Cancer and Leukemia Group B Statistical Center, University of Iowa CALGB Institutional Grant, Cancer and Leukemia Group B, Cancer and Leukemia Group B: RPCI/SUNYAB, Cancer and Leukemia Group B, CANCER AND LEUKEMIA GROUP B, Cancer and Leukemia Group B, NCTN Lead Academic Participating Site at Dana-Farber/Partners Cancer Care, Alliance for Clinical Trials in Oncology Operations Center
OpenAlex ID: W2290293600