Predictors of lymph node and intrapulmonary metastasis in clinical stage IA non-small cell lung carcinoma

Background. The feasibility of limited surgical resection for clinical stag e IA non-small cell lung cancer still remains controversial. Methods. From July 1987 through April 1998, 389 patients with clinical stag e IA disease underwent major lung resection and complete mediastinal lymph node dissection. Univariate and multivariable analyses were performed to de termine predictors of local or regional tumor spread: pathologic lymph node involvement, intrapulmonary metastases, and lymphatic invasion. Results. Of the 389 patients, 88 (23%) had lymph node involvement or intrap ulmonary metastases pathologically. According to multivariable analyses, gr ade of differentiation and pleural involvement were significant predictors of local or regional tumor spread (p < 0.01). Based on these results, more than 40% of clinical stage IA non-small cell lung cancer patients showed pa thologic lymph node involvement or intrapulmonary metastases, or both, if t he patients had both of the predictors of pathologic local or regional invo lvement: moderate or poor differentiation of the primary tumor and pleural involvement by tumor cells. Conclusions. Limited surgical resection is not feasible for clinical stage IA non-small cell lung cancer, especially when the tumor shows moderate or poor differentiation, or pleural involvement. (C) 2001 by The Society of Th oracic Surgeons.