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Standard pathology practice frequently leaves large numbers of N1 LNs unexamined, a clinically significant proportion of which harbor metastasis. By improving N1 LN examination, SPE can have an impact on prognosis and adjuvant management. We suggest adoption of the SPE to improve pathologic staging of resected NSCLC.

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Background. Neuroendocrine tumors (NETs) are commonly treated with multimodality therapy. The combination of capecitabine and temozolomide (CAPTEM) has been suggested as a treatment option for patients with metastatic NETs. We present our experience with CAPTEM. Methods. Data on NET patients who were placed on CAPTEM and received at least one cycle were obtained from a Velos eResearch database. Response rate was calculated by RECIST 1.1. Overall survival and progression-free survival (PFS) were calculated by the Kaplan-Meier survival method. Results. A total of 29 patients (17 male and 12 female) were included. Median age at CAPTEM initiation was 58 years (range: 26-77). Primary tumors included 9 small bowel (31%), 15 pancreas (52%), 3 lung (10%), and 2 rectum (7%). Median number of CAPTEM cycles was 8 (range: 1-55). Partial response occurred in 5 patients (5 of 29, 17%); 14 patients

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Background Pathologic nodal stage is a key prognostic factor for patients with surgically resected lung cancer. We previously described the extent of missed intrapulmonary nodal metastasis in a cohort of patients treated at metropolitan Memphis, TN institutions. With long-term follow-up, we now quantify the survival impact of missed nodal metastasis. Methods We conducted a prospective cohort study to evaluate inadvertently discarded lymph nodes in re-dissected remnant lung resection specimens from lung cancer patients. Retrieved material was histologically examined and classified as lymph nodes with and without metastasis. Survival information was obtained from hospital cancer registries. We plotted survival distributions using the Kaplan Meier method and evaluated them with proportional hazards models controlling for significant demographic and clinical factors. Results The study included 110 patients who were 54% female and 69% Caucasian. Discarded lymph nodes with metastasis were found in 25 (23%) patients. Patients with missed lymph node metastasis had an increased risk of death with an unadjusted hazard ratio of 2.0 (p-value= 0.06) and an adjusted hazard ratio of 1.4 (p-value=0.45) compared with those without missed lymph node metastasis. Patients with >2 missed lymph nodes with metastasis had 4.8 (p-value=0.0005) times the hazard of death compared to patients without missed lymph node metastasis (adjusted hazard ratio =6.5, p-value=0.0001). Conclusions Metastasis to inadvertently discarded intrapulmonary lymph nodes from lung cancer resection specimens was associated with reduced survival. A more rigorous gross dissection protocol for lung cancer resection specimens may provide prognostically useful information.