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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2019

01-08-2019 | NSCLC | Thoracic Oncology

Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy

Authors: Jie Qian, MD, Jianlin Xu, MD, PhD, Shuyuan Wang, MD, Fangfei Qian, MD, Wenjia Yang, MD, Bo Zhang, MD, Yanwei Zhang, MD, PhD, Wei Nie, MD, PhD, Yuqing Lou, MD, PhD, Jun Lu, MD, PhD, Xueyan Zhang, MD, PhD, Wei Zhang, MD, PhD, Tianqing Chu, MD, PhD, Hua Zhong, MD, PhD, Wentao Fang, MD, PhD, Heng Zhao, MD, PhD, Baohui Han, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2019

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Abstract

Background

This study aimed to explore adjuvant chemotherapy (ACT) candidates based on a recurrence risk-scoring model in completely lobectomized stage I patients with lung adenocarcinoma (LAD).

Methods

A retrospective study was performed on 4606 patients (non-ACT group: n = 3514; ACT group: n = 1092) who underwent complete lobectomy for LAD at Shanghai Chest Hospital from 2008 to 2014. The nomogram predicting recurrence-free survival (RFS) was developed in the non-ACT group using Cox proportional hazards regression. The nomogram-based risk score was calculated in the entire cohort. Differences of RFS between the non-ACT and ACT groups were compared as stratified by the risk score. The score cut-off points were determined using the X-tile software.

Results

Six independent predictors, including age, sex, tumor size, pathological subtype, visceral pleural invasion (VPI), and lymphovascular invasion (LVI) were associated with RFS. The nomogram more accurately predicted RFS than the 8th TNM staging {C-index: 0.784 [95% confidence interval (CI) 0.756–0.812] vs. 0.719 (95% CI 0.689–0.749), p = 0.0017}. A significant RFS difference was observed among the low-, intermediate- and high-risk groups (p < 0.0001), as divided by the optimal cut-points of risk score (203 and 244). ACT did not improve RFS for patients at intermediate-risk, or was even detrimental for low-risk patients; however, improved RFS was observed in ACT receivers at high-risk (p = 0.0416). ACT candidates with a risk score ≥ 245 constituted 2.6% of stage I patients.

Conclusions

The nomogram provided an individual prediction of RFS for stage I LAD following lobectomy. High-risk patients (score ≥ 245) may benefit from postoperative ACT.
Appendix
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Metadata
Title
Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy
Authors
Jie Qian, MD
Jianlin Xu, MD, PhD
Shuyuan Wang, MD
Fangfei Qian, MD
Wenjia Yang, MD
Bo Zhang, MD
Yanwei Zhang, MD, PhD
Wei Nie, MD, PhD
Yuqing Lou, MD, PhD
Jun Lu, MD, PhD
Xueyan Zhang, MD, PhD
Wei Zhang, MD, PhD
Tianqing Chu, MD, PhD
Hua Zhong, MD, PhD
Wentao Fang, MD, PhD
Heng Zhao, MD, PhD
Baohui Han, MD, PhD
Publication date
01-08-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07366-z

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