Elsevier

The Annals of Thoracic Surgery

Volume 68, Issue 3, September 1999, Pages 1039-1042
The Annals of Thoracic Surgery

Original Articles: General Thoracic
Extrathoracic staging is not necessary for non-small-cell lung cancer with clinical stage T1–2 N0

https://doi.org/10.1016/S0003-4975(99)00694-3Get rights and content

Abstract

Background. In the official guidelines published recently, radiographic staging procedures were not recommended for patients who have non−small-cell lung cancer with negative clinical evaluation.

Methods. We did a retrospective analysis of 755 patients with non−small-cell lung cancer in clinical stage T1–2 N0 between 1982 and 1996. The patients all had a full series of imaging procedures, based on the staging protocol. Their medical records were reviewed with respect to how often distant metastasis was detected by these procedures and whether the patients showed any symptoms and laboratory abnormalities indicating extrathoracic metastasis.

Results. The incidence of distant metastasis detected by the imaging procedures was 2.1% (nine of 419) in T1 N0 cases and 5.4% (18 of 335) in T2 N0 cases. Silent metastasis was found only in 0.5% (2 of 419) of the T1 N0 cases and 0.9% (3 of 335) of the T2 N0 cases. The cost of these staging procedures was approximately one million dollars.

Conclusions. Considering the cost and time savings, staging procedures are not warranted for patients with non−small-cell lung cancer stage T1–2 N0 with negative clinical evaluations.

Section snippets

Patients and methods

We analyzed records of all patients with a histologic diagnosis of lung cancer, referred to the National Cancer Center Hospital East and the National Matsudo Hospital (former institute of the National Cancer Center Hospital East) between January 1982 and May 1996. The staging protocol during this period consisted of enhanced chest CT, radioisotope bone scanning, enhanced MRI or CT of the brain, and abdominal enhanced CT or ultrasonography.

Eight hundred three patients had NSCLC in clinical stage

Results

Of the 419 clinical T1 N0 cases, nine (2.1%) extrathoracic metastases were detected by radiographic staging procedures (Table 2). Seven of nine had clinical findings of distant metastasis. Of the 335 clinical T2 N0 cases, 20 distant metastatic sites in 18 patients (5.4%) were detected. Fifteen of the 18 patients had the clinical findings. All these metastases detected by the imaging procedures were confirmed as true positive by following their clinical courses.

The metastatic sites and the

Comment

This large volume retrospective study determined the frequency of detection of extrathoracic metastasis in NSCLC patients with clinical stage T1–2 N0, and the incidence of clinical and laboratory abnormalities suggestive of distant metastasis in this population.

Our results showed that even if a tumor does not seem to invade any lymph nodes on chest CT, distant metastasis can be detected by full staging procedures. However, the imaging procedures could provide accurate staging in only a few

Acknowledgements

This study was supported in part by a Grant-in-Aid for Cancer Research (8S-1, 9-18, 9-29) from the Japanese Ministry of Health and Welfare.

References (18)

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