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J Thorac Cardiovasc Surg 1999;117:736-743
© 1999 Mosby, Inc.
GENERAL THORACIC SURGERY |
From the Thoracic Oncology Program, Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, NC.
Supported by National Cancer Institute grant R29 CA73980.
Read at the Twenty-fourth Annual Meeting of The Western Thoracic Surgical Association, Whistler, British Columbia, June 24-27, 1998.
Received for publication July 15, 1998. revisions requested Sept 8, 1998. revisions received Nov 13, 1998. Accepted for publication Dec 10, 1998. Address for reprints: Thomas A. D'Amico, MD, Duke University Medical Center, Box 3496, Durham, NC 27707.
Objective: The standard treatment of patients with stage I nonsmall cell lung cancer is resection of the primary tumor; however, the recurrence rate is 28% to 45%. This study evaluates a panel of molecular markers in a large population of patients with stage I nonsmall cell lung cancer to determine the prognostic value of each marker and to create a biologic risk model.
Methods: Pathologic specimens were collected from 408 consecutive patients after complete resection for stage I nonsmall cell lung cancer at a single institution, with follow-up of at least 5 years. A panel of 10 molecular markers was chosen for immunohistochemical analysis of the primary tumor on the basis of differing oncogenic mechanisms. Local tumor expansion requires growth regulating proteins (epidermal growth factor receptor, the protooncogene erb-b2); apoptosis proteins (p53, bcl-2); and cell cycle regulating proteins (retinoblastoma recessive oncogene, KI-67). Local tumor invasion requires angiogenesis (factor viii). The development of distant metastases involves the expression of adhesion proteins (CD-44, sialyl-Tn, blood group A). Cox proportional hazards regression analysis was used to construct an independent risk model for cancer recurrence and death.
Results: Multivariable analysis demonstrated significantly elevated risk for the following molecular markers: p53 (hazard ratio, 1.68; P = .004); factor viii (hazard ratio, 1.47 P = .033); erb-b2 (hazard ratio, 1.43; P = .044); CD-44 (hazard ratio, 1.40; P = .050); and retinoblastoma recessive oncogene (hazard ratio, 0.747; P = .084).
Conclusions: Five molecular markers were associated with the risk of recurrence and death, representing independent metastatic pathways: apoptosis (p53), angiogenesis (factor viii), growth regulation (erb-b2), adhesion (CD-44), and cell cycle regulation (retinoblastoma recessive oncogene). This study demonstrates the validity of this molecular biologic risk model in patients with stage I non small cell lung cancer.
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