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Ann Thorac Surg 2007;83:400-401
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Invited commentary

Centre de Pneumologie de Laval, 2725 Chemin Sainte-Foy, Quebec City, Quebec, G1V 4G5 Canada

(Email: hopitallaval.chir-thor{at}ssss.gouv.qc.ca).

In 1997, Dr Clifford F. Mountain [1] reviewed survival data on a combined total of 5,319 patients, and he proposed multiple revisions in the staging system of lung cancer. These revisions were subsequently adopted by the American Joint Committee on Cancer Staging and Union Internationale Contre le Cancer. Despite these improvements, significant variability still exists within stage groups.

The issue of "multifocal" nonsmall cell lung cancer is particularly difficult to address not only because such cases are uncommon, so that their natural behavior is largely unknown and only based on small retrospective series, but also because the terminology used varies from one country to another, and often from one investigator to the other. For example, should these cases be reported as primary lung cancers with satellite nodules? In this case I would concur with the authors that the prognosis after complete surgical resection is better than the T4 designation would indicate. Alternatively, should they be reported as multifocal tumors that happen to be located in the same lobe and in which case, other sites will likely show up during mid-term and long-term follow-up? This article which provides a rigorous analysis of resected patients with multifocal nonsmall cell lung cancer illustrates very well the limitations inherent in the study of these patients.

From my perspective, one important message of this article [2] is that one should not make a clinical judgment based solely on preoperative imaging, because satellite lesions identified on computed tomography are often benign, and even if they turn out to be malignant, surgery still provides the best therapeutic option.

	References

Top References

 

1. Mountain CF. Revisions in the international system for staging lung cancer Chest 1997;111:1710.[Medline]
2. Port JL, Korst RJ, Lee PC, Kansler A, Kerem Y, Altorki NK. Surgical resection for multifocal (t4) non-small cell lung cancer: is the T4 designation valid? Ann Thorac Surg 2007;83:397-401.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jean Deslauriers Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Deslauriers, J. Search for Related Content PubMed PubMed Citation Articles by Deslauriers, J. Related Collections Lung - cancer Related Article