Overlooked Lymph Nodes in Rib Cage Have Prognostic Power for Mesothelioma Patients

Newswise — SYDNEY, AUSTRALIA—For the first time, researchers from the Perelman School of Medicine at the University of Pennsylvania have shown the predictive power of a group of overlooked lymph nodes--known as the posterior intercostal lymph nodes--that could serve as a better tool to stage and ultimately treat patients with malignant pleural mesothelioma.

The findings were presented October 28 at the 15th World Conference on Lung Cancer.

Physicians look to lymph nodes to stage essentially all cancers, including mesothelioma. The presence or absence of metastatic cancer cells in lymph nodes affects prognosis and also typically dictates the optimal treatment strategy. But posterior intercostal lymph nodes, which are located between the ribs near the spine, have not been previously used to stage or guide treatment of malignant pleural mesothelioma or any other cancer.

In a retrospective study of 48 Penn Medicine patients undergoing radical pleurectomy for malignant pleural mesothelioma, Joseph S. Friedberg, MD, Chief of the Section of Thoracic Surgery at Penn Presbyterian Medical Center and Co-Director of the Penn Mesothelioma and Pleural Disease Program, and colleagues found that over half the patients had cancer metastatic to these lymph nodes and that, in some of these patients, those were the only lymph nodes containing metastatic cancer.

Patients who did not have cancer in the posterior intercostal lymph nodes had significantly longer overall survival rates, nearly two and half years longer, compared to those who did have cancer in the lymph nodes.

“I am unaware of any other group that is sampling these nodes. They are not currently part of the staging system for mesothelioma, or any other cancer for that matter,” said Dr. Friedberg. “What we have shown here is that even though these lymph nodes are not described in relation to this cancer, they are highly significant.”

The conclusion of the study was that surgeons should routinely biopsy these lymph nodes as part of any surgery-based treatment for mesothelioma and that these lymph nodes should be included in any revision of the mesothelioma staging system.

“ Ultimately, it means that the presence or absence of cancer in these lymph nodes could help guide the treatment of pleural mesothelioma,” said Dr. Friedberg.

This study is one of a 13 Penn Medicine studies and talks being presented at the International Association for the Study of Lung Cancer’s 15th World Conference on Lung Cancer.

Co-authors from Penn Medicine Melissa Culligan, Mary Putt, Stephen M. Hahn, Evan Alley, Charles Simone, Daniel Sterman, and Keith A. Cengel.

##Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $398 million awarded in the 2012 fiscal year.The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2012, Penn Medicine provided $827 million to benefit our community.