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[Micro-metastases and non-small cell lung cancer]
P Saintigny1, F Le Pimpec-Barthes, J F Bernaudin
1Service d'Histologie-Biologie Tumorale, UPRES EA 3499, Université Paris VI, Hôpital Tenon, France.
Introduction:
Non-small cell lung cancer has a poor prognosis, including those with operable, apparently localised, disease. Preoperative staging investigations and histo-pathological analysis are poor at detecting small clusters of tumour cells, particularly in lymph nodes.
State Of The Art:
New methods based on immunohistochemistry, or molecular biology, have been developed to detect these so-called micro-metastases. We present a ten-year review of the literature published on this topic.
Perspective:
These publications primarily reported on the detection of micro-metastases within mediastinal lymph nodes removed at operation in order to identify patients at risk of recurrence, for whom adjuvant therapy might be offered.
Conclusions:
Lymph node micro-metastases have been demonstrated to be an independent prognostic factor for survival, especially in stage I patients. On the other hand, the presence of bone marrow micro-metastases did not appear to be of significant prognostic value in non-small-cell lung cancer. Finally, the clinical relevance of circulating tumour cells is still debatable, although recent published studies show interesting results.