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J Thorac Cardiovasc Surg 2002;124:299-305
© 2002 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Preoperative evidence of circulating tumor cells by means of reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen messenger RNA is an independent predictor of survival in non–small cell lung cancer: A prospective study

From the Department of Surgery II,^a Kumamoto University School of Medicine, and the Department of Thoracic Surgery,^b Kumamoto Chuo Hospital, Kumamoto, Japan.

This work was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Education, Science and Culture of Japan.

Received for publication Oct 23, 2001. Revisions requested Dec 26, 2001; revisions received Jan 2, 2002. Accepted for publication Feb 16, 2002. Address for reprints: Michio Ogawa, MD, Department of Surgery II, Kumamoto University School of Medicine, Honjo 1-1-1, Kumamoto 860-8556, Japan (E-mail: yamaj{at}kaiju.medic.kumamoto-u.ac.jp).

Objective: We conducted a prospective study of 103 consecutive patients with non-small cell lung cancer who underwent a curative lobectomy to test whether circulating tumor cells detected in the peripheral blood by means of reverse transcriptase-polymerase chain reaction of carcinoembryonic antigen messenger RNA is a prognostic indicator independent of tumor stage in patients with non-small cell lung cancer.
Methods: We assayed for carcinoembryonic antigen messenger RNA by means of reverse transcriptase-polymerase chain reaction in peripheral blood taken at the time of diagnosis before an operation and again 2 to 3 weeks after an operation from patients with non-small cell lung cancer who underwent a curative lobectomy between March 1996 and April 1998. We analyzed the prognostic value of carcinoembryonic antigen messenger RNA expression in the patients with non-small cell lung cancer in a univariate and multivariate manner.
Results: Patients with carcinoembryonic antigen messenger RNA in the preoperative blood samples had a poor survival when compared with those without carcinoembryonic antigen messenger RNA. Of these patients, the worst survival was seen in those with carcinoembryonic antigen messenger RNA in the postoperative blood samples. The multivariate stepwise analysis selected the preoperative carcinoembryonic antigen messenger RNA expression (P = .0004; relative risk, 0.21) and the pathologic stage of disease (P = .0002; relative risk, 1.43) as the independent prognostic factors for survival.
Conclusions: The molecular detection of carcinoembryonic antigen messenger RNA in the preoperative peripheral blood is an independent prognostic factor in patients with non-small cell lung cancer who undergo a curative operation.

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