ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goldstein, N. S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Goldstein, N. S.
Related Collections
Right arrowRelated Article

Ann Thorac Surg 2000;69:1648-1649
© 2000 The Society of Thoracic Surgeons

Correspondence

Analysis of stage I lung carcinoma patients including p53 and Rb protein

Neal S. Goldstein, MDa

a Department of Anatomic Pathology, William Beaumont Hospital, 3601 West Thirteen Mile Rd, Royal Oak, MI 48073, USA,

e-mail: ngoldstein{at}beaumont.edu

To the Editor

I read the study by Lee and associates with great interest [1]. The authors found that p53 nuclear positivity was the only significant parameter associated with survival length among stage I patients using multivariate analysis. Their data may help to identifying stage I patients who may benefit from adjuvant therapy. This is a pressing question because there are ongoing clinical studies that are examining the effectiveness of adjuvant therapy in stage I non-small cell carcinoma patients. Because most stage I patients are surgically cured, I believe these studies run the risk of finding no adjuvant therapy benefit for the entire stage I patient group due to statistical wash-out effects of the surgically cured patients.

We recently studied 218 patients with completely excised, T1, N0, M0, adenocarcinomas or bronchioloalveolar carcinomas, and found that maximum tumor dimension, lymphatic space (small vessel) vascular space invasion, nuclear grade, and increased central fibrosis were independently associated with metastases and decreased disease-free survival [2]. The patients with all four negative prognostic features had a disease-free survival rate similar to patients with stage III carcinomas, strongly suggesting that this is the subgroup for which adjuvant therapy may be most beneficial. We limited our study to this patient group because it is one of the more common tumor types and stages encountered by thoracic surgeons. Maximum tumor dimension was analyzed as continuous and categorical variables with the same results. Figures 1 and 2



View larger version (11K):
[in this window]
[in a new window]
  		Fig 1. Survival curves of Stage I lung cancer patients with tumor size > 3 cm or <= 3 cm (p = 0.015).

 


View larger version (11K):
[in this window]
[in a new window]
  		Fig 2. p53 indices in Stage I lung cancers with tumor size > 3 cm or <= 3 cm (p = 0.48).

 
In this vein, I ask Dr Lee and associates to provide additional information and data regarding these features. I believe that this information is vital, and ask the editor to allow adequate space for the authors’ reply. The database that the authors have compiled is invaluable and rare. It should be mined to its limits. Additionally, the lack of this information possibly hampers the clinical application of their findings. Did the authors parameter "vascular invasion or emboli" include large venous invasion, or was it limited to small vascular spaces? Many authors have found no significance of the former, while the latter feature has strong prognostic value. The authors did not study maximum tumor dimension. What are the analysis results when the authors add maximum tumor dimension as either a continuous or categorical variable to the stage I patient group multivariate analysis? A patient with a stage I, 1-cm tumor may not have the same failure risk as a patient with a stage I, 7-cm tumor. The authors may find that p53 staining results may not be significant when these variables are refined.

References

  1. Lee Y.-C., Chang Y.-L., Luh S.-P., Lee J.-M., Chen J.-S. Significance of p53 and Rb protein expression in surgically treated non-small cell lung cancers. Ann Thorac Surg 1999;68:343-348.[Abstract/Free Full Text]
  2. Goldstein N.S., Mani A., Chmielewski G., Welsh R., Pursel S. Prognostic factors in stage T1, N0, M0 adenocarcinomas and bronchioloalveolar carcinomas of the lung. Am J Clin Pathol 1999;112:391-402.[Medline]

Related Article

Reply
Yung-Chie Lee, Yih-Leong Chang, Shi-Ping Luh, Jang-Ming Lee, and Jin-Shing Chen
Ann. Thorac. Surg. 2000 69: 1648. [Extract] [Full Text] [PDF]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goldstein, N. S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Goldstein, N. S.
Related Collections
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS