PROGNOSTIC IMPLICATIONS OF PULMONARY SATELLITE NODULES - ARE THE 1997STAGING REVISIONS APPROPRIATE

In the 1992 AJCC and 1993 UICC staging systems, primary lobe satellite nodules increased the T designation of the primary by one level and i psilateral non-primary lobe satellite nodules raised the T designation to T4. The recent 1997 UICC and AJCC staging revisions assign a T4 (I IIb) designation to satellite nodules in a primary lobe, and a M1 (IV) designation to satellites in ipsilateral non-primary lobes. There is abundant evidence showing that satellite nodules are negative prognost ic factors, but their inclusion in stage IIIb and IV may not be approp riate. The English-language medical literature was searched for papers reporting survival after surgical resection of lung cancer with satel lite nodules (primary and non-primary ipsilateral lobe locations). Ele ven articles were retrieved and their data pooled for analysis. Of 568 resected patients with satellite nodules, actuarial 5-year survival w as 20%. Five articles gave separate survival data for satellite nodule s in primary versus ipsilateral non-primary lobes. All five articles s howed better survival for satellite nodules in a primary lobe. Satelli te nodules in a primary lobe have a better prognosis than those in ips ilateral non-primary lobes. Survival for resected lung cancer with sat ellite nodules in a primary lobe is better than that usually observed for T4 (IIIB) disease. The 1997 staging revisions may unduly upstage p atients with satellite nodules in a primary cancer lobe. However, sate llite nodules in ipsilateral non-primary lobes share metastatic mechan isms and have survival results consistent with M1 stage disease. Their 1997 M1 designation may be appropriate. (C) 1998 Elsevier Science Ire land Ltd. All rights reserved.