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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2014

Open Access 01-12-2014 | Research

Risk factors of recurrence for resected T1aN0M0 invasive lung adenocarcinoma: a clinicopathologic study of 177 patients

Authors: Fan Yang, Kezhong Chen, Yida Liao, Xiao Li, Kunkun Sun, Dongmei Bao, Jun Wang

Published in: World Journal of Surgical Oncology | Issue 1/2014

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Abstract

Background

This study aimed at identifying risk factors of recurrence for completely resected pathologic T1aN0M0 lung adenocarcinomas.

Methods

We reviewed the records of 177 T1aN0M0 invasive adenocarcinoma patients, and re-classified achieved surgical specimens according to the new International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) lung adenocarcinoma classification. Impact on recurrence-free survival (RFS) for age, gender, smoking history, lymphovascular invasion (LVI) and new classification was analyzed by log-rank test and Cox regression. Two existing prognostic grouping schemes of new classification were compared, and subsequently, the correlation of high-grade group in the better prognostic grouping model with clinical data was investigated statistically.

Results

The 5-year recurrence-free rate was 83.7%. The LVI and new adenocarcinoma classification were significantly associated with 5-year RFS (P = 0.012; P = 0.022, respectively). The designation of papillary predominant subtype in the low-grade group, along with lepidic- and acinar predominant subtype had more prognostic significance than the model of combining papillary-, solid- and micropapillary predominant subtypes as the high-grade group (P = 0.005 versus P = 0.181). This high-grade group has increased risk of recurrence in a multivariate Cox regression (adjusted HR 2.815, 95% CI: 1.239 to 6.397, P = 0.013), and is associated significantly more with male gender (adjusted OR 2.214, 95% CI: 1.050 to 4.668, P = 0.037), and, with borderline significance, the presence of LVI (adjusted OR 2.091, 95% CI: 0.938 to 4.662, P = 0.071).

Conclusions

Our results showed that the solid- and micropapillary predominant subtype of IASLC/ATS/ERS classification remains the only risk factor for post-operative recurrence of T1aN0M0 adenocarcinomas, suggesting that they can be indicators of aggressive tumor behaviors.
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Literature
1.
Siegel R, Naishadham D, Jemal A: Cancer statistics, 2013. CA Cancer J Clin. 2013, 63: 11-30. 10.3322/caac.21166.CrossRefPubMed
2.
Alberg AJ, Brock MV, Ford JG, Samet JM, Spivack SD: Epidemiology of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013, 143: e1S-e29S. 10.1378/chest.12-2345.CrossRefPubMed
3.
Field JK, Oudkerk M, Pedersen JH, Duffy SW: Prospects for population screening and diagnosis of lung cancer. Lancet. 2013, 382: 732-741. 10.1016/S0140-6736(13)61614-1.CrossRefPubMed
4.
Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S: Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013, 368: 1980-1991.CrossRefPubMed
5.
Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC: Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013, 143: e278S-e313S. 10.1378/chest.12-2359.CrossRefPubMed
6.
Rami-Porta R, Ball D, Crowley J, Giroux DJ, Jett J, Travis WD, Tsuboi M, Vallieres E, Goldstraw P: The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007, 2: 593-602. 10.1097/JTO.0b013e31807a2f81.CrossRefPubMed
7.
Zhang J, Wu J, Tan Q, Zhu L, Gao W: Why do pathological stage IA lung adenocarcinomas vary from prognosis?: a clinicopathologic study of 176 patients with pathological stage IA lung adenocarcinoma based on the IASLC/ATS/ERS classification. J Thorac Oncol. 2013, 8: 1196-1202. 10.1097/JTO.0b013e31829f09a7.CrossRefPubMed
8.
Sakurai H, Asamura H, Goya T, Eguchi K, Nakanishi Y, Sawabata N, Okumura M, Miyaoka E, Fujii Y: Survival differences by gender for resected non-small cell lung cancer: a retrospective analysis of 12,509 cases in a Japanese Lung Cancer Registry study. J Thorac Oncol. 2010, 5: 1594-1601. 10.1097/JTO.0b013e3181f1923b.CrossRefPubMed
9.
Park SY, Lee JG, Kim J, Bae MK, Lee CY, Kim DJ, Chung KY: The influence of smoking intensity on the clinicopathologic features and survival of patients with surgically treated non-small cell lung cancer. Lung Cancer. 2013, 81: 480-486. 10.1016/j.lungcan.2013.07.002.CrossRefPubMed
10.
Sakai T, Tsushima T, Kimura D, Hatanaka R, Yamada Y, Fukuda I: A clinical study of the prognostic factors for postoperative early recurrence in patients who underwent complete resection for pulmonary adenocarcinoma. Ann Thorac Cardiovasc Surg. 2011, 17: 539-543. 10.5761/atcs.oa.11.01660.CrossRefPubMed
11.
12.
Oyama M, Miyagi Maeshima A, Tochigi N, Tsuta K, Kawachi R, Sakurai H, Watanabe S, Asamura H, Tsuda H: Prognostic impact of pleural invasion in 1,488 patients with surgically resected non-small cell lung carcinoma. Jpn J Clin Oncol. 2013, 43: 540-546. 10.1093/jjco/hyt039.CrossRefPubMed
13.
Tao H, Hayashi T, Sano F, Takahagi A, Tanaka T, Matsuda E, Okabe K: Prognostic impact of lymphovascular invasion compared with that of visceral pleural invasion in patients with pN0 non-small-cell lung cancer and a tumor diameter of 2 cm or smaller. J Surg Res. 2013, 185: 250-254. 10.1016/j.jss.2013.05.104.CrossRefPubMed
14.
Strano S, Lupo A, Lococo F, Schussler O, Loi M, Younes M, Bobbio A, Damotte D, Regnard JF, Alifano M: Prognostic significance of vascular and lymphatic emboli in resected pulmonary adenocarcinoma. Ann Thorac Surg. 2013, 95: 1204-1210. 10.1016/j.athoracsur.2012.12.024.CrossRefPubMed
15.
Matsuguma H, Oki I, Nakahara R, Suzuki H, Kasai T, Kamiyama Y, Igarashi S, Mori K, Endo S, Yokoi K: Comparison of three measurements on computed tomography for the prediction of less invasiveness in patients with clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2013, 95: 1878-1884. 10.1016/j.athoracsur.2013.02.022.CrossRefPubMed
16.
Yanagawa N, Shiono S, Abiko M, Ogata SY, Sato T, Tamura G: New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage I lung adenocarcinoma. J Thorac Oncol. 2013, 8: 612-618. 10.1097/JTO.0b013e318287c3eb.CrossRefPubMed
17.
David E, Thall PF, Kalhor N, Hofstetter WL, Rice DC, Roth JA, Swisher SG, Walsh GL, Vaporciyan AA, Wei C, Mehran RJ: Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size. Ann Thorac Surg. 2013, 95: 1872-1877. 10.1016/j.athoracsur.2013.03.085. Discussion 1877PubMedCentralCrossRefPubMed
18.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D: International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011, 6: 244-285. 10.1097/JTO.0b013e318206a221.PubMedCentralCrossRefPubMed
19.
Hung JJ, Jeng WJ, Chou TY, Hsu WH, Wu KJ, Huang BS, Wu YC: Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification on death and recurrence in completely resected stage I lung adenocarcinoma. Ann Surg. 2013, 258: 1079-1086. 10.1097/SLA.0b013e31828920c0.CrossRefPubMed
20.
Russell PA, Wainer Z, Wright GM, Daniels M, Conron M, Williams RA: Does lung adenocarcinoma subtype predict patient survival?: a clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. J Thorac Oncol. 2011, 6: 1496-1504. 10.1097/JTO.0b013e318221f701.CrossRefPubMed
21.
Igai H, Matsuura N, Tarumi S, Chang SS, Misaki N, Go T, Ishikawa S, Yokomise H: Clinicopathological study of p-T1aN0M0 non-small-cell lung cancer, as defined in the seventh edition of the TNM classification of malignant tumors. Eur J Cardiothorac Surg. 2011, 39: 963-967. 10.1016/j.ejcts.2010.09.008.CrossRefPubMed
22.
Igai H, Matsuura N, Tarumi S, Chang SS, Misaki N, Ishikawa S, Yokomise H: Prognostic factors in patients after lobectomy for p-T1aN0M0 adenocarcinoma. Eur J Cardiothorac Surg. 2012, 41: 603-606. 10.1093/ejcts/ezr006.CrossRefPubMed
23.
Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC: Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013, 143: e211S-e250S. 10.1378/chest.12-2355.CrossRefPubMed
24.
Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH: Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002, 346: 92-98. 10.1056/NEJMoa011954.CrossRefPubMed
25.
Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, Gemma A, Harada M, Yoshizawa H, Kinoshita I, Fujita Y, Okinaga S, Hirano H, Yoshimori K, Harada T, Ogura T, Ando M, Miyazawa H, Tanaka T, Saijo Y, Hagiwara K, Morita S, Nukiwa T: Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 2010, 362: 2380-2388. 10.1056/NEJMoa0909530.CrossRefPubMed
26.
Matsuo K, Ito H, Yatabe Y, Hiraki A, Hirose K, Wakai K, Kosaka T, Suzuki T, Tajima K, Mitsudomi T: Risk factors differ for non-small-cell lung cancers with and without EGFR mutation: assessment of smoking and sex by a case–control study in Japanese. Cancer Sci. 2007, 98: 96-101. 10.1111/j.1349-7006.2006.00347.x.CrossRefPubMed
27.
Russell PA, Barnett SA, Walkiewicz M, Wainer Z, Conron M, Wright GM, Gooi J, Knight S, Wynne R, Liew D, John T: Correlation of mutation status and survival with predominant histologic subtype according to the new IASLC/ATS/ERS lung adenocarcinoma classification in stage III (N2) patients. J Thorac Oncol. 2013, 8: 461-468. 10.1097/JTO.0b013e3182828fb8.CrossRefPubMed
28.
Yoshizawa A, Motoi N, Riely GJ, Sima CS, Gerald WL, Kris MG, Park BJ, Rusch VW, Travis WD: Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Mod Pathol. 2011, 24: 653-664. 10.1038/modpathol.2010.232.CrossRefPubMed
29.
Warth A, Muley T, Meister M, Stenzinger A, Thomas M, Schirmacher P, Schnabel PA, Budczies J, Hoffmann H, Weichert W: The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol. 2012, 30: 1438-1446. 10.1200/JCO.2011.37.2185.CrossRefPubMed
30.
Gu J, Lu C, Guo J, Chen L, Chu Y, Ji Y, Ge D: Prognostic significance of the IASLC/ATS/ERS classification in Chinese patients - a single institution retrospective study of 292 lung adenocarcinoma. J Surg Oncol. 2013, 107: 474-480. 10.1002/jso.23259.CrossRefPubMed
31.
Woo T, Okudela K, Mitsui H, Tajiri M, Yamamoto T, Rino Y, Ohashi K, Masuda M: Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases. Pathol Int. 2012, 62: 785-791. 10.1111/pin.12016.CrossRefPubMed
32.
Nitadori J, Colovos C, Kadota K, Sima CS, Sarkaria IS, Rizk NP, Rusch VW, Travis WD, Adusumilli PS: Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma </=2 cm: a proposal to reclassify T1 lung adenocarcinoma. Chest. 2013, 144: 1622-1631. 10.1378/chest.13-0394.PubMedCentralCrossRefPubMed
33.
Yoshida J, Nagai K, Asamura H, Goya T, Koshiishi Y, Sohara Y, Eguchi K, Mori M, Nakanishi Y, Tsuchiya R, Miyaoka E: Visceral pleura invasion impact on non-small cell lung cancer patient survival: its implications for the forthcoming TNM staging based on a large-scale nation-wide database. J Thorac Oncol. 2009, 4: 959-963. 10.1097/JTO.0b013e3181a85d5e.CrossRefPubMed
34.
Riquet M, Assouad J, Bagan P, Foucault C, Le Pimpec Barthes F, Dujon A, Danel C: Skip mediastinal lymph node metastasis and lung cancer: a particular N2 subgroup with a better prognosis. Ann Thorac Surg. 2005, 79: 225-233. 10.1016/j.athoracsur.2004.06.081.CrossRefPubMed
35.
Nitadori J, Bograd AJ, Kadota K, Sima CS, Rizk NP, Morales EA, Rusch VW, Travis WD, Adusumilli PS: Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2 cm or smaller. J Natl Cancer Inst. 2013, 105: 1212-1220. 10.1093/jnci/djt166.PubMedCentralCrossRefPubMed
36.
Nitadori JI, Bograd AJ, Morales EA, Rizk NP, Dunphy MP, Sima CS, Rusch VW, Adusumilli PS: Preoperative consolidation-to-tumor ratio and SUVmax stratify the risk of recurrence in patients undergoing limited resection for lung adenocarcinoma </=2 cm. Ann Surg Oncol. 2013, 20: 4282-4288. 10.1245/s10434-013-3212-2.PubMedCentralCrossRefPubMed
37.
Warth A, Cortis J, Fink L, Fisseler-Eckhoff A, Geddert H, Hager T, Junker K, Kayser G, Kitz J, Langer F, Morresi-Hauf A, Ott G, Petersen I, Stenzinger A, Soltermann A, Ting S, Tischler V, Vollmer E, Schnabel PA, Weichert W: Training increases concordance in classifying pulmonary adenocarcinomas according to the novel IASLC/ATS/ERS classification. Virchows Arch. 2012, 461: 185-193. 10.1007/s00428-012-1263-6.CrossRefPubMed
38.
Kadota K, Colovos C, Suzuki K, Rizk NP, Dunphy MP, Zabor EC, Sima CS, Yoshizawa A, Travis WD, Rusch VW, Adusumilli PS: FDG-PET SUVmax combined with IASLC/ATS/ERS histologic classification improves the prognostic stratification of patients with stage I lung adenocarcinoma. Ann Surg Oncol. 2012, 19: 3598-3605. 10.1245/s10434-012-2414-3.PubMedCentralCrossRefPubMed
39.
Yoshizawa A, Sumiyoshi S, Sonobe M, Kobayashi M, Fujimoto M, Kawakami F, Tsuruyama T, Travis WD, Date H, Haga H: Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol. 2013, 8: 52-61. 10.1097/JTO.0b013e3182769aa8.CrossRefPubMed
40.
Sun PL, Seol H, Lee HJ, Yoo SB, Kim H, Xu X, Jheon S, Lee CT, Lee JS, Chung JH: High incidence of EGFR mutations in Korean men smokers with no intratumoral heterogeneity of lung adenocarcinomas: correlation with histologic subtypes, EGFR/TTF-1 expressions, and clinical features. J Thorac Oncol. 2012, 7: 323-330. 10.1097/JTO.0b013e3182381515.CrossRefPubMed
41.
Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, Macchiarini P, Crapo JD, Herold CJ, Austin JH, Travis WD: Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology. 2013, 266: 304-317. 10.1148/radiol.12120628.CrossRefPubMed
42.
Nakao M, Yoshida J, Goto K, Ishii G, Kawase A, Aokage K, Hishida T, Nishimura M, Nagai K: Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules. J Thorac Oncol. 2012, 7: 1563-1566. 10.1097/JTO.0b013e3182641b5c.CrossRefPubMed
Metadata
Title
Risk factors of recurrence for resected T1aN0M0 invasive lung adenocarcinoma: a clinicopathologic study of 177 patients
Authors
Fan Yang
Kezhong Chen
Yida Liao
Xiao Li
Kunkun Sun
Dongmei Bao
Jun Wang
Publication date
01-12-2014
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2014
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-12-285

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