gms | German Medical Science

Background: Non-small-cell-lung-cancer (NSCLC) shows a poor chance of 5-year survival, even after curative resection of the tumour. TNM- categories presently applied for pT1 carcinomas do not entirely reflect the different biological features of NSCLC e.g. localaziation of the tumor, tumor size and absence of pleural infiltration. Therefore, additional parameters for enhanced tumor staging of pT1 lung carcinomas should be established for individual therapeutical strategies.

Methods: A period of five years (1999 to 2005) was selected for the present study. 126 patients with pT1 non-small-cell-lung-cancer received systematic mediastinal lymhadenectomie in the clinic for thoracic surgery, HSK Wiesbaden. The histopathological grading of the tumors (G) as well as the nodal stage (pN) were determined and statistically correlated.

Results: 84 patients (67%) showed a negative nodal stage (N0), in 18 (14%) lymph node metastases were detected in stage N1 lymph nodes. 19 (15%) patients showed positive N2 and 5 (4%) showed positive N3 lymph nodes. The stage of lymph node metastasis correlated with histological grading. In the group of nodal negative patients (84), 25 carcinomas (30%) were graded G1, 39 (46%) G2 and 20 (24%) G3. In contrast, in the group of nodal positive patients (42) only 1 (2%) carcinoma was graded G1, 19 (45%) carcinomas were graded G2 and 22 (52%) G3.

Conclusion: Our data demonstrates a positive correlation of tumor grading and nodal stage in pT1 NSCLC. High tumor grading appears to result in a greater extend of lymph node metastasis and should therefore be regarded as a positive predictive factor.