Pathologic stage I non–small cell lung cancer with high levels of preoperative serum carcinoembryonic antigen: Clinicopathologic characteristics and prognosis

Matsuguma, Haruhisa; Nakahara, Rie; Igarashi, Seiji; Ishikawa, Yoshinori; Suzuki, Haruko; Miyazawa, Naoto; Honjo, Satoshi; Yokoi, Kohei

doi:10.1016/j.jtcvs.2007.09.032

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 1 , Pages 44-49, January 2008

Pathologic stage I non–small cell lung cancer with high levels of preoperative serum carcinoembryonic antigen: Clinicopathologic characteristics and prognosis

Haruhisa Matsuguma, MD
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
- Address for reprints: Haruhisa Matsuguma, MD, Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi 320-0834, Japan.
Rie Nakahara, MD
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
Seiji Igarashi, MD
- Division of Pathology, Tochigi Cancer Center, Utsunomiya, Japan
Yoshinori Ishikawa, MD
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
- Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Haruko Suzuki, MD
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
- Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Naoto Miyazawa, MD
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
Satoshi Honjo, MD
- Division of Epidemiology, Tochigi Cancer Center, Utsunomiya, Japan
- Pediatrics Unit, Oomuta National Hospital, National Hospital Organization, Oomuta, Japan.
Kohei Yokoi, MD
- Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
- Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

Received 16 April 2007; received in revised form 24 August 2007; accepted 11 September 2007.

Objective

Surgery alone remains the standard therapy for patients with stage I non–small cell lung cancer. Although the preoperative serum level of carcinoembryonic antigen has been shown to be an independent prognostic factor, it has not yet been included in the staging system and does not alter the treatment strategy, especially in the selection of patients for adjuvant chemotherapy.

Methods

From 1986 to 2003, preoperative and postoperative serum carcinoembryonic antigen levels were measured in 455 patients with completely resected pathologic stage I non–small cell lung cancer. We compared the clinicopathologic characteristics and outcomes among patients who had preoperative serum carcinoembryonic antigen levels within the normal range (N group, n = 323), patients who had high carcinoembryonic antigen levels before surgery but normal levels after surgery (HN group, n = 112), and patients who had high carcinoembryonic antigen levels before and after surgery (HH group, n = 20).

Results

The significant characteristics of the HN group included the male sex, greater age, smoking, squamous cell histology, T2 status, lymphatic invasion, vascular invasion, and pleural invasion. Adenocarcinomas in patients of the HN group were more likely to be moderately to poorly differentiated. The 5-year survivals in the HN and HH groups were significantly lower (56.2% and 43.1%, respectively) than those in the N group (85.9%). Multivariate analysis revealed that greater age, non-adenocarcinoma histology, pleural invasion, and the carcinoembryonic antigen in the HN and HH groups were independent prognostic factors.

Conclusion

Patients with resected pathologic stage I non–small cell lung cancer and high preoperative serum carcinoembryonic antigen levels are a subgroup with a distinctly poor prognosis who display smoking-related clinicopathologic characteristics.

Abbreviations and Acronyms: BVI, blood vessel invasion, CEA, carcinoembryonic antigen, NSCLC, non–small cell lung cancer, VPI, visceral pleural invasion