P1-017: Prognotic value of plasma D-Dimer levels in lung carsinoma

Abstract

Background: Mediastinal lymph node metastasis is one of the most principal prognostic factors in lung cancer treatment. N2 patients have a poor prognosis compared to N1, N0 cases. Histological diagnosis of mediastinal lymph node metastasis is necessary for the indication of surgery. There are several methods to examine the mediastinal lymphadenopathy, such as mediastinoscopy, endobronchial ultrasoundguided trans-bronchial needle aspiration (EBUS-TBNA) and etc. but it is neither practical nor clinically possible, however, to use mediastinoscopy or EBUS for all patients with primary lung cancer. Methods: A prospective phase II study of indications for surgery, using video-assisted mediastinoscopy (VAM) and EBUS-TBNA to detect mediastinal lymph node metastasis was conducted in patients with resectable primary lung cancer of clinical stages I-IIIA. Indications for VAM were based on tumor size, CT findings and tumor markers, and patients were placed in group V ( VAM or EBUS) or group A ( thoracotomy without VAM) accordingly. EBUS-TBNA was performed if the CT findings showed mediastinal lymph nodes larger than 15 mm in the shortest axis. Mediastinal lymph node involvement confirmed by VAM or EBUS was treated with chemotherapy followed by thoracotomy (group C) or radiotherapy (group D), and cases without detected metastasis underwent thoracotomy and systematic lymph node dissection (group B). Group A patients had primary tumor resection and lymph node sampling and group C patients, tumor resection and extended dissection of mediastinal lymph nodes via median sternotomy. Results: Of the 500 eligible cases who were introduced to our center between Oct. 1998 and Des.2006, 249 underwent VAM (group V) and 217 had thoracotomy without VAM (group A). EBUS-TBNA was indicated for 34 patients. Of the VAM patients, 189 negative patients for metastasis received thoracotomy and 60 positive cases received 2 courses of chemotherapy and 28 responders received thoracotomy and 32 non-responders received radiation or best supportive care. Twelve negative cases by EBUS-TBNA received thoracotomy and 22 positive cases received chemotherapy. Six responders received thoracotomy and 16 non-responders received radiation. The two-and 5-year survival rates of groups A, and B were 94.8%, and 90.0% (group A), and 90.8% and 59.1% (group B), respectively, while the 2-year rate in Group C was 68.0%. Conclusions:We have demonstrated the usefulness of indication criteria for VAM and EBUS for the selection of candidates for primary lung cancer surgery. These indication criteria enabled us to avoid doing valueless examinations and to avoid unnecessary thoracotomy. The more favorable group A outcomes indicated both successful selection by these criteria of patients not requiring mediastinal examination, and superfluity of complete lymph node dissection, proper lymph nodes sampling being sufficient for staging.