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Significance of extramucosal residual tumor at the bronchial resection margin
L R Kaiser1, P Fleshner, S Keller
1Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Abstract:
Extramucosal microscopic residual disease (MRD) at the bronchial resection margin was identified in 45 (1.6%) of 2,890 patients who underwent resection of primary non-small cell lung cancer between 1975 and 1985. In 9 of these patients, residual tumor was confined to submucosal lymphatics, whereas in the other 36, MRD was found in peribronchial soft tissue. All patients underwent complete mediastinal lymphadenectomy. Three patients had stage I disease, 3 had stage II, 33 had stage IIIa, 4 had stage IIIb, and 2 had stage IV. Recurrent disease developed in 34 (81%) of the evaluable patients; the recurrence was local in 11 (32%). Median time from operation to diagnosis of local recurrence was 8 months. Sixty percent of the recurrences in the N0 group were local, and only 23% of those in the N2 group were local. Extramucosal MRD is most frequently associated with advanced-stage disease. Postoperative therapy had no effect on the development of recurrent disease. We found no difference in survival between patients whose initial site of recurrence was local as opposed to distant. Median survival after the identification of either local or distant recurrence was 5 months. The finding of extramucosal MRD identifies a subset of patients with a poorer prognosis compared with those with clear resection margins.
Insights
Microscopic residual disease (MRD) after lung cancer surgery indicates a poor prognosis. This finding in non-small cell lung cancer patients significantly increases recurrence risk and shortens survival, regardless of recurrence location.
Area of Science:
- Oncology
- Thoracic Surgery
- Pathology
Background:
- Microscopic residual disease (MRD) at bronchial resection margins is a critical factor in lung cancer recurrence.
- Identifying extramucosal MRD is crucial for risk stratification in non-small cell lung cancer (NSCLC).
Purpose of the Study:
- To investigate the prognostic significance of extramucosal microscopic residual disease (MRD) in patients with primary non-small cell lung cancer (NSCLC).
- To determine the association between extramucosal MRD and recurrence patterns, survival, and the impact of advanced stage disease.
Main Methods:
- Retrospective analysis of 2,890 patients undergoing primary NSCLC resection between 1975 and 1985.
- Evaluation of extramucosal MRD at bronchial resection margins and complete mediastinal lymphadenectomy.
- Analysis of recurrence rates, timing, location, and survival based on MRD status and disease stage.
Main Results:
- Extramucosal MRD was found in 1.6% of patients, predominantly in advanced stages (IIIa, IIIb, IV).
- 81% of patients with MRD experienced recurrence, with 32% being local.
- No significant difference in survival was observed between local and distant recurrence; median survival post-recurrence was 5 months.
Conclusions:
- Extramucosal MRD identifies a high-risk NSCLC subset with significantly poorer prognosis.
- MRD is strongly associated with advanced disease and high recurrence rates.
- Postoperative therapy did not influence recurrence development in patients with MRD.