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Skip metastases point to improved outcome in lung cancer


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Skip metastases point to improved outcome in lung cancer

Reuters Health

Posting Date: May 19, 2004

Last Updated: 2004-05-19 15:45:06 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with non-small cell lung carcinoma (NSCLC) and "skip metastasis" appear to have a more favorable outcome than those with continuous involvement in both regions, German researchers report in the May 1st issue of Cancer.

Skip metastases are those to the subcarinal lymph node and/or the ipsilateral internal mammary or mediastinal lymph nodes - also known as the pN2 lymph nodes - but that do not exhibit N1 infiltration.

Dr. Klaus L. Prenzel and colleagues at the University of Cologne note that little is known about the behavior of tumors with non-continuous spread to the mediastinal lymph nodes.

To investigate, the researchers retrospectively analyzed primary tumor specimens from 45 patients with pN2 NSCLC. Of these patients, 18 had squamous cell carcinoma, 23 had adenocarcinomas and 4 had large cell carcinomas.

The overall 5-year survival was 41% in the 17 patients with skip metastases, compared to 14% in those without skip metastasis.

In 3 of the skip metastasis patients, micrometastatic tumor involvement of the pN1 lymph nodes was detected. However, even after their inclusion in the non-skip group, there still was a significant difference in survival between groups.

The team notes that tumor specimens from the skip apoptosis group showed lower levels of the anti-apoptosis gene BCL2 and lower expression of p21 than did those from the other group.

However, they conclude that "further study of a larger sample of patients is needed to elucidate additional mechanisms underlying this form of metastasis."

Cancer 2004;100:1909-1915.

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I'm with Eline. I'm not sure what the term skip mets means either. It sounds like they mean mediastinal adenopathy WITHOUT the involvement of more local (closer) nodes (to the primary tumor). If so I'm thinking that group probably includes a lot of us????

Dave S

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Joe explained it. It means you get a "higher" node that is positive but the lower node is not positive. I think the lymph travels from nodes 1 to nodes 3. if one of the lower nodes is not positive but the higher ones are positive it means a lymph node was "skipped"

There may be a positive subcarnial node which is N2, but a negative N1 node, so N1 was skipped

According the TNM. N is N1, N2, N3. N3 is the most advanced (for lack of a better word).

The nodes are mapped starting from the lower chest to the upper chest (on the same side). Once a node is positive on the opposite side (contralateral) it makes it N3 automatically (I think)

BTW there is also a thing called a thoracic regional node map. It names the node stations from 1-13. In this case the smaller numbers are "worse". I was really confused when my mom was diagnosed and the surgeon kept on talking about node 4, when all I had read about is N0 through N3.

http://www.chestx-ray.com/StagingLungCa ... pNode.html

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