Bronchogenic carcinoma: Survival after surgical treatment according to stage, histologic type and immunomorphologic changes in regional lymph nodes

Abstract

The survival rates of 90 patients who underwent operation for bronchogenic carcinoma were analyzed statistically according to sex, age, tumor stage and histologic type, types of surgical procedures (lobectomy or pneumonectomy), and to immunomorphologic parameters of immunologic activity in peribronchial and hilar lymph nodes. The Stage I group survived significantly longer than did the Stage II and III groups, the lobectomized patients survived significantly longer than the pneumonectomized patients. The absence or presence of lymph node metastases was one of the major determinants of survival. The mean values (percent of total node cut surface) of lymph node sinus histiocytosis and of paracortical area could be correlated directly to survival in each of the histologic tumor-type groups, while the development of follicular cortex and germinal centers correlated inversely with survival. Increased survival might be associated with changes concomitant with immune reactivity in lymph node T-cell areas and with the sinus histiocytosis pattern, the latter representing probably a tumor--host reaction of the delayed hypersensitivity type. By contrast, increased activity of lymph node B-cell areas tended to correlate with poor prognosis of lung cancer patients. Moreover, patterns showing germinal center hyperplasia were statistically associated with lymph node neoplastic invasion, while the pattern with sinus histiocytosis and expanded paracortical areas was statistically associated with tumor-free lymph nodes.

Host defense and survival in patients with lung carcinoma

“…15-18,24 -26,28,41-52 Among the few studies seeking information on locoregional responses and long term survival in patients who underwent surgery for carcinoma of the lung, in a series of 90 patients, Tosi et al 28 found, as we did, that long term survival was correlated directly with the development of cellular immunity and inversely with the development of a humoral immune response in the locoregional nodes. When a host reaction develops, the major determinant of a good prognosis is the cellular response, and the humoral immune response has an adverse or doubtful effect on survival.…”

“…15-18,24 -26,28,41-52 Among the few studies seeking information on locoregional responses and long term survival in patients who underwent surgery for carcinoma of the lung, in a series of 90 patients, Tosi et al 28 found, as we did, that long term survival was correlated directly with the development of cellular immunity and inversely with the development of a humoral immune response in the locoregional nodes. 14,26,28,[61][62][63] In the current assessment of long term survival, the Cox analysis, including the host immune response and standard prognostic factors for lung carcinoma, such as pathologic disease stage and cell type, identified host immune responses in locoregional lymph nodes and at the primary tumor site as the independent variables with the greatest predictive power. In a series of 29 patients who were treated for bronchogenic squamous cell carcinoma, Kauffman 27 found direct correlations between lymph node morphology and survival, for both cellular and humoral histologic variables.…”

“…The male predominance in our study (157 men vs. 15 women) made all comparison between the genders meaningless. 25,28,35 The relation between the development of a humoral response and lymph node metastatic growth remains unclear. Even though patients with small cell lung carcinoma tended to be less reactive, we found no significant differences in lymph node immunomorphologic features between the two groups (Table 2).…”

Prognostic value and therapeutic consequences of vascular invasion in non-small cell lung carcinoma

“…Small cell carcinoma, which also carries an extremely poor prognosis and has constituted up to 33% of the cases in other studies of prognosis [23], was also excluded, not least because surgery does not represent the first line of treatment here.…”

Sarcoidal reactions in regional lymph nodes of patients with early stage non–small cell lung cancer predict improved disease-free survival: a pilot case-control study

“…Two studies have described improved survival in patients with NSCLC in whom lymph nodes exhibited SH [18,19]. SH is a histologic finding describing histiocytic (macrophage) infiltration of the marginal and medullary sinuses of lymph nodes (Fig.…”