Risk factors of recurrence for resected T1aN0M0 invasive lung adenocarcinoma: a clinicopathologic study of 177 patients
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Risk factors of recurrence for resected T1aN0M0 invasive lung adenocarcinoma: a clinicopathologic study of 177 patients Fan Yang1, Kezhong Chen1, Yida Liao1, Xiao Li1, Kunkun Sun2, Dongmei Bao2 and Jun Wang1*
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. Keywords: Lung adenocarcinoma, Recurrence, New classification, Solid predominant adenocarcinoma, Micropapillary predominant adenocarcinoma
Background Lung carcinoma is one of leading causes of cancer death worldwide, and its incidence rate continues to increase [1]. Adenocarcinoma is the most common histologic type of lung cancer, especially among Chinese women [2]. The widespread use of computed tomography (CT) screening encouraged by positive results of the National Lung * Correspondence: [email protected] 1 Department of Thoracic Surgery, Peking University People’s Hospital, 11 Xizhimen Nan Ave, Beijing 100044, China Full list of author information is available at the end of the article
Screening Trial is detecting more and more early-staged adenocarcinomas [3,4]. T1aN0M0 constitutes the earliest stag
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