Clinicopathological Analysis of Clinical N0 Peripheral Lung Cancers with a Diameter of 1 cm or Less

Abstract

Background: The appropriateness of limited resection for small-sized lung cancer continues to be debated. It is not yet clear whether tumor size alone is a reliable indicator for limited resection. Methods: From 1980 to 2002, 27 patients with clinical N0 peripheral lung cancers having diameters of 1 cm or less underwent pulmonary resection. Clinicopathological features of these cases were reviewed retrospectively. Results: Histological analysis showed that there were 23 cases of adenocarcinoma (81.5 %), two large cell carcinomas (7.4 %), and two carcinoid tumors. Twenty-two cases were classified as pathological stage 1, one was stage II, and four were stage III. Four patients (14.8 %) had lymphatic vessel invasion, three (11.1 %) had lymph node metastasis, and two (7.4 %) had intrapulmonary metastasis. The 5-year disease-free survival rate was 76.6 %. Conclusions: It is impossible to predict the effectiveness of an intentional limited resection for lung cancer using only tumor size.

Key words

Lung cancer - small-sized - peripheral - limited resection - lymph node metastasis

References

• 1 Ginsberg R, Vokes E, Raben A. Non-small cell lung cancer. De Vita V Jr., Helleman S, Rosenberg S Cancer, Principles and Practice of Oncology. Philadelphia; Lippencott-Raven 1997: 858-911
• 2 Kaneko M, Eguchi K, Ohmatsu H. et al . Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography.  Radiology. 1996;  201 798-802
• 3 Sone S, Takashima S, Li F. et al . Mass screening for lung cancer with mobile spiral computed tomography scanner.  Lancet. 1998;  351 1242-1245
• 4 Henschke C I, McCauley D I, Yankelevitz D F. et al . Early Lung Cancer Action Project: overall design and findings from baseline screening.  Lancet. 1999;  354 99-105
• 5 Tsubota N, Ayabe K, Doi O. et al . Ongoing prospective study of segmentectomy for small lung tumors.  Ann Thorac Surg. 1998;  66 1787-1790
• 6 Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller?.  Ann Thorac Surg. 2001;  71 956-960
• 7 Dales R E, Stark R M, Raman S. Computed tomography to stage lung cancer. Approaching a controversy using meta-analysis.  Am Rev Respir Dis. 1990;  141 1096-1101
• 8 Pretreatment evaluation of non-small-cell lung cancer . The American Thoracic Society and The European Respiratory Society.  Am J Respir Crit Care Med. 1997;  156 320-332
• 9 Kaplan E, Meier P. Non-parametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
• 10 World Health Organization .Histological Typing of Lung and Pleural Tumours. 3rd ed. Berlin; Springer-Verlag 1999
• 11 Cahan W G. Radical lobectomy.  J Thorac Cardiovasc Surg. 1960;  39 555-572
• 12 Lung Cancer Study Group . Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer.  Ann Thorac Surg. 1995;  60 615-623
• 13 Asamura H, Nakayama H, Kondo H, Tsuchiya R, Shimosato Y, Naruke T. Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these candidates for video-assisted lobectomy?.  J Thorac Cardiovasc Surg. 1996;  111 1125-1134
• 14 Ohta Y, Oda M, Wu J. et al . Can tumor size be a guide for limited surgical intervention in patients with peripheral non-small cell lung cancer? Assessment from the point of view of nodal micrometastasis.  J Thorac Cardiovasc Surg. 2001;  122 900-906
• 15 Yoshida J, Nagai K, Yokose T. et al . Primary peripheral lung carcinoma smaller than 1 cm in diameter.  Chest. 1998;  114 710-712
• 16 Miller D L, Rowland C M, Deschamps C, Allen M S, Trastek V F, Pairolero P C. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter.  Ann Thorac Surg. 2002;  73 1545-1551
• 17 Riquet M, Manac'h D, Le Pimpec Barthes F, Dujon A, Debrosse D, Debesse B. Prognostic value of T and N in non small cell lung cancer three centimeters or less in diameter.  Euro J Cardio Thoracic Surg. 1997;  11 440-444
• 18 Noguchi M, Morikawa A, Kawasaki M. et al . Small adenocarcinoma of the lung.  Cancer. 1995;  75 2844-2852
• 19 Kodama K, Higashiyama M, Yokouchi H. et al . Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning.  Lung Cancer. 2001;  33 17-25