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Upfront Surgery for c-Stage IIIB Non-Small Cell Lung Cancer with an Abnormally High Preoperative Serum
Ryuki Tsunemi1, Ryusuke Sumiya1, Shinsuke Uchida1
1Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Introduction:
Carcinoembryonic antigen (CEA) is one of the most widely used tumor markers in clinical practice. In non-small cell lung cancer, elevated preoperative serum CEA levels have been reported to be associated with a poor prognosis.
Case Presentation:
A 43-year-old man with primary lung cancer of the right upper lobe was referred to our hospital. Initial blood tests revealed a markedly elevated serum CEA level of 1160.0 ng/mL. Chest CT identified a 55-mm tumor in the right hilar region, with enlargement of the right hilar and prevascular (#3a) lymph nodes (c-T3N2M0, Stage IIIB according to the Union for International Cancer Control tumor-node-metastasis classification, 8th edition). The patient underwent a type A extended sleeve lobectomy and pulmonary vein transposition. However, due to suspected pulmonary venous return failure, a right completion pneumonectomy was performed on POD 7. The patient's serum CEA levels returned to the normal range within 2 months postoperatively. He has remained recurrence-free for more than 4 years since the surgery.
Conclusions:
This case highlights that upfront surgery may be a valid treatment option in selected patients with c-Stage IIIA or IIIB disease, even in the presence of an abnormally high preoperative serum CEA level.
