Occult Metastases in Lymph Nodes Predict Survival in Resectable Non–Small-Cell Lung Cancer: Report of the ACOSOG Z0040 Trial

Abstract

In early-stage NSCLC, LN OMs detected by IHC identify patients with a worse prognosis. Future clinical trials should test the role of IHC in identifying patients for adjuvant therapy.

Improving post-resection risk stratification in non-small cell lung cancer: ‘wit, whither wander you?’

“…In analysis restricted to the pN0 subset of 580 patients and without stratification by the pN-category of IHC-positive lymph nodes, the IHCpositivity rate was 22%, and IHC positivity was associated with a hazard ratio of 1.63 (95% CI, 1.13-2.36; P=0.009) for DFS and 1.59 (95% CI, 1.13-2.23; P=0.007) for OS. This result was consistent in a multivariable analysis adjusting for age, sex and histology (12).…”

“…What should we make of these somewhat disappointing results from a prospective multi-institutional study involving patients from 11 US academic institutions and with central analysis of IHC and RT-PCR? It helps to contrast this study with a larger multi-institutional study, the American College of Surgeons Oncology Group (ACOSOG) Z0040 trial (12). That study, also prospective, included a larger number of institutions and patients, including patients with resectable stage I-IIIB disease.…”

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

“…In a review of more than 6,500 patients undergoing (7). The sensitivity of these techniques improve using immunohistochemistry antibodies to cytokeratins, or other molecular detector with reverse transcriptase polymerase chain reaction (RT-PCR) methodology but this has not been proven to definitively impact survival or recurrence rates (8,9).…”

Impact of lymph node occult metastases in stage I non-small cell lung cancer (NSCLC): what is the evidence?

“…Another similar trial was conducted by the American College of Surgeons Oncology Group in 2011 (the ACOSOG Z0040 trial) (18). In this study, 1,047 patients with resectable stage I to IIIB NSCLC were treated with surgical resection and systematic LNs sampling or dissection.…”

“…In fact, a possible explanation for these high rates of failure might be the presence of occult micro-metastatic sites that remain undetected by standard staging methods, already present systemically at the time of surgery, suggesting that there is an underestimation of the true tumour stage. According to this hypothesis, various studies have been conducted to investigate the presence of occult tumour cells in the pleural lavage (11), peripheral blood (12), bone marrow (13,14) and in the lymph nodes (LNs) (15)(16)(17)(18) of patients with NSCLC.…”