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Ann Thorac Surg 2003;76:1832
© 2003 The Society of Thoracic Surgeons

Invited commentary

Division of Cardiothoracic SurgeryUniversity of North Carolina at Chapel HillCB #7065Medical School Wing C, Room 354 Chapel Hill, NC 27599-7065 USA

e-mail: fdetter{at}med.unc.edu

At the beginning of this new millennium, many established concepts are being seriously questioned, such as the idea that there is no role for screening for lung cancer; that all non-small cell lung cancers (NSCLC) behave more or less the same; and that lobectomy is the procedure of choice for an early NSCLC. Although we are accustomed to looking for progress in the form of new technology or medications, history shows us that a leap forward often comes in the shape of new ideas.

As we look out over the changing landscape, we are struggling to see things in a more appropriate light. Patients are turning up with small lesions detected by CT alone. Is there a spectrum of biologic behavior among lung cancers? Are there some lung cancers for which limited resection is appropriate? Are there lung cancers for which no treatment (observation alone) is appropriate? Does overdiagnosis bias actually exist? The answers to these questions are quite unclear at this time, but it is clear that there is a whole series of new concepts to be defined.

In order to begin to answer these questions, we must first look for innovative ways to predict prognosis preoperatively. Possible characteristics include the tumor disappearance ratio (TDR), the intensity of PET uptake, the expression of certain oncogenes, or the presence of circulating tumor cells. The TDR, as reported by Okada et al [1], is particularly appealing because it is simple, noninvasive, uses well-established technology in an innovative way, is prospectively available, and is applicable to CT detected tumors, where the need for a prognostic test is the greatest.

The TDR is partially corroborated by the correlation of the TDR and nodal involvement reported by others, and by the data indicating the prognostic value of the amount of ground glass opacity of small lung cancers. It holds up to multivariate analysis, although the impact of limited resection or bronchioloalveolar carcinoma was not analyzed in the model. However, the TDR must be validated in other centers before it can be generally embraced. Nevertheless, the TDR is an innovative new approach that we should take careful note of as we move ahead to redefine the prognosis and treatment of lung cancer in the current era.

References

1. Okada M., Nishio W., Sakamoto T., Uchino K., Tsubota N. Discrepancy of computed tomographic image between lung and mediastinal windows as a prognostic implication in small lung adenocarcinoma. Ann Thorac Surg 2003;76:1828-1832.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frank C. Detterbeck Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Detterbeck, F. C. Search for Related Content PubMed Articles by Detterbeck, F. C. Related Collections Lung - cancer