Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA non-small cell lung cancer

Abstract

Background: Radical segmentectomy has been performed for small-sized non-small cell lung cancer (NSCLC). However, underestimation of mediastinal lymph node metastasis in the absence of hilar or interlobar metastasis (skip N2) affects surgical strategy. Our aim was to investigate preoperative and intraoperative predictors of skip N2 in clinical stage (c-stage) IA NSCLC. Methods: From 1998 to 2011, 279 patients (155 men and 124 women) with c-stage IA NSCLC (230 pN0, 17 pN1, 12 skip N2, 20 non-skip N2) underwent systematic lobectomy (R0 resection) at our institute. We compared preoperative serum concentrations of carcinoembryonic antigen, cytokeratin 19 fragment, sialyl Lewis X (SLX), and preand intraoperative clinicopathological features of pN0 and skip N2 patients. Receiver operator characteristic (ROC) curve analysis was performed to distinguish between the two patient groups. Results: The 5-year survival rate of skip N2 patients was 78.6%, higher than that of non-skip N2 patients (44.9%), and not significantly different than that of pN0 (86.7%) or pN1 patients (82.4%). The mean serum SLX concentration in skip N2 patients (28.0 U/ml) was elevated compared to that in pN0 patients (22.9 U/ml). In ROC analysis of SLX, the area under the curve was 0.710, and the optimal cut-off value was 21.4 U/ml (sensitivity, 91.7%; specificity, 51.7%). In multivariate analysis, SLX was an independent predictor of skip N2 in patients with c-stage IA NSCLC (odds ratio, 9.43; p = 0.006). Conclusions: Skip N2 metastasis is common in patients with c-stage IA NSCLC with high serum SLX, and lobectomy with complete dissection of hilar and mediastinal lymph nodes should remain the standard surgical procedure for these cases.

CD15s/CD62E Interaction Mediates the Adhesion of Non-Small Cell Lung Cancer Cells on Brain Endothelial Cells: Implications for Cerebral Metastasis

“…Similar findings were shown by Kadota et al (1999) [ 34 ], suggesting CD15s correlates with distant metastatic lesions in lung carcinoma. Recently, elevated levels of CD15s were reported to be used as an independent marker to predict NSCLC patients at the metastatic stage [ 35 ], although, little is known about CD15s expression in CNS malignancies. We recently reported that CD15s overexpression was cell cycle dependent in high grade glioblastoma cells as well as in metastatic brain tumour cells originating from lung [ 36 ].…”

Role of Cytokine-Induced Glycosylation Changes in Regulating Cell Interactions and Cell Signaling in Inflammatory Diseases and Cancer

“…The modifications of cell glycosylation observed in cancers mainly affect the outer part of glycans, leading to the expression of cell surface antigenic sialylated structures that are strongly associated with a poor prognosis in certain tumors [1,2,3]. For example, sialyl-Lewis a (sLe a ) and sialyl-Lewis x (sLe x ) antigens are abnormally found on glycoproteins and glycolipids in several types of solid tumors and sLe x /selectin interactions are clearly involved in metastatic progression of gastric [4], lung [5] and prostate [6] cancers. These changes of cell glycosylation are mainly supported by the deregulation of the expression of glycosyltransferases (GTs) genes implicated in terminal glycosylation.…”

Skip lymph node metastasis in gastric cancer: is it skipping or skipped?

“…However, sometimes metastatic LNs can be detected far from the original tumor without being detected in the peritumoral area, which has been called skip metastasis. This unusual pattern of LN metastasis has been reported in various cancers, such as breast, colon, and lung cancer [3][4][5]. Several studies have also reported on skip metastasis in gastric cancer [7][8][9], in which the following factors could play a role: (1) occult metastasis or micrometastasis which was missed during routine examination of the perigastric (PG) area [10]; (2) direct lymphatic flow from the tumor to LNs in the extraperigastric (EP) area, bypassing the PG area [11-13; and (3) free cancer cells passing through PG LNs because of an unfit microenvironment for settling [14].…”