Ann Thorac Surg 2005;80:433
© 2005 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
Scott Swanson, MD
Mt. Sinai Medical Center, 1190 5th Ave, New York, NY 10029
(Email: scott.swanson{at}mountsinai.org).
The article by Mineo and his colleagues from Rome describes a retrospective review of a single surgeon’s experience with resection for endobronchial carcinoid in 55 patients. They report excellent 5 and 10 year survival rates in patients with both typical and atypical tumors. Of interest, using immunohistochemical (IHC) techniques the authors looked for micrometastatic disease in the lymph nodes of those patients found to be negative by usual histologic evaluation. The markers they chose were AE1/AE3 anti-cytokeratin and cromogranin A (CgA) antibodies. Nearly 20% of the patients (8/43) showed positivity and thus were felt to have micrometastatic nodal disease. Five of the 55 patients developed recurrence (9%), 3/5 were IHC positive and 2/5 were IHC negative. So, 3/8 IHC positive patients had recurrent disease and 5/8 IHC positive patients did not. At 5 years, those patients who were IHC negative were all disease free whereas 83% of patients who were IHC positive were disease free. The numbers are quite small but this type of analysis may have some predictive ability above and beyond current staging.
This report is another effort to improve our understanding of neoplastic disease. There is no question that usual histologic evaluation with hematoxylin and eosin staining does not adequately assess the metastatic potential of a tumor. Herein we see that even for tumors that generally behave in a much more favorable way than typical non-small cell lung cancer, we can begin to identify subgroups that behave more aggressively. Others have done this type of molecular staging in non-small cell lung cancer and esophageal cancer with similar ability to identify the "bad actors" [1, 2]. Clearly this is the future for cancer. Only when we can better understand the biology of the tumor will we be able to develop more homogeneous and effective treatment strategies that will lead to improved survival—ie, tailor the treatment to the behavior not the color of the tumor.
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References
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- Kwiatkowski DJ, Harpole Jr. DH, Godleski J, et al. Molecular pathologic substaging in 244 stage I non-small cell lung cancer patientsclinical implications. J Clin. Oncol 1998;16(7):2468-2477.[Abstract]
- Xi L, Luketich JD, Raja S, et al. Molecular staging of lymph nodes from patients with esophageal adenocarcinoma Clin Cancer Res 2005;11(3):1099-1109.[Abstract/Free Full Text]
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