The Prognostic Significance of Isolated Tumor Cells and Micrometastases in Patients with Non-Small Cell Carcinoma of the Lung: Systematic Review of Current Best Evidence with Meta-Analysis
AM Marchevsky, R Gupta. Cedars Sinai Medical Center, LA, CA
Background: The prognostic value of isolated tumor cells (ITC) and micrometastases (MM) remains controversial for non-small cell carcinoma of the lung (NSCLC) patients.
Design: The English literature for NSCLC was systematically reviewed for best evidence regarding the prognostic value of ITC and MM detected by IHC and/or molecular methods. The data were analyzed with metaanalysis (Comprehensive Meta-analysis Biostat, Englewood NJ).
Results: Sixteen retrospective cases series (level III studies) reported the prognosis of 906 NSCLC patients evaluated with IHC using antibodies to keratins, CEA, Ber-EP4 or p53. Three other studies evaluated 140 NSCLC patients with molecular methods. Metaanalysis of the survival information available from patients evaluated with IHC and/or molecular methods showed no significant survival differences between pN0, pN0 (i+) and pN1(mi) cases and between patients with pN0 or pN1 and pN2(mi) (p> 0.05). Concordance between IHC and molecular findings was 76.9% in the single study where both methods were used. Evaluation of the data with funnel plots and Eggers regression intercept showed significant heterogeneity and asymmetry within the data resulting from publication and other biases.
Conclusions: Available best evidence shows that ITC and MM detected with IHC and molecular methods do not provide significant prognostic information for NSCLC patients. The available data shows significant heterogeneity. Additional evidence is needed before these tests are recommended for the routine pathologic staging of NSCLC patients.
Monday, March 9, 2009 1:00 PM
Poster Session II # 220, Monday Afternoon