Takahiro Mimae1, Yasuhiro Tsutani1, Yoshihiro Miyata1, Tomoharu Yoshiya1, Yuta Ibuki1, Kei Kushitani2, Yukio Takeshima2, Haruhiko Nakayama3, Sakae Okumura4, Masahiro Yoshimura5, Morihito Okada6. 1. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. 2. Department of Pathology, Hiroshima University, Hiroshima, Japan. 3. Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan. 4. Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan. 5. Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan. 6. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. Electronic address: morihito1217@hiroshima-u.ac.jp.
Abstract
OBJECTIVE: Some patients with clinical T1 N0 M0 lung adenocarcinoma have pathologic lymph node metastasis. However, neither the precise prognosis nor the factors predictive of the prognosis of such patients have yet been identified. METHODS: Our study included 609 patients with clinical T1 N0 M0 lung adenocarcinoma; 568 (93.3%) pathologic node negative [pN(-)] and 41 (6.7%) pathologic node positive [pN(+)] patients, diagnosed after complete surgical resection. The association between prognosis and pathologic findings was analyzed retrospectively. RESULTS: pN(+) patients had a significantly lower lepidic growth component ratio (10% vs 50%), a higher lymphatic invasion (LI) rate (68% vs 11%), vessel invasion rate (59% vs 14%), and visceral pleural invasion rate (29% vs 9%), compared with pN(-) patients (all Ps < .001). Surprisingly, 13 of 41 (32%) pN(+) patients showed no LI. In pN(-) patients, a multivariate analysis of recurrence-free survival revealed that lower lepidic growth component ratio, and lymphatic, vessel, and pleural invasion were significantly correlated with a poor prognosis (P = .008, .045, .031, and .024). However, in pN(+) patients, the multivariate analysis of recurrence-free survival showed that only LI was a significant independent prognostic factor (P = .037). The 5-year recurrence-free survival rates were as follows: 91.2% for pN(-)/LI(-) patients, 68.2% for pN(-)/LI(+) patients, 63.5% for pN(+)/LI(-) patients, and 41.9% for pN(+)/LI(+) patients. LI status stratified the prognosis not only in patients with no nodal metastasis but also in those with metastasis. CONCLUSIONS: LI, which is not always present in node-positive adenocarcinoma, is an important prognostic variable in patients with node involvement.
OBJECTIVE: Some patients with clinical T1 N0 M0 lung adenocarcinoma have pathologic lymph node metastasis. However, neither the precise prognosis nor the factors predictive of the prognosis of such patients have yet been identified. METHODS: Our study included 609 patients with clinical T1 N0 M0 lung adenocarcinoma; 568 (93.3%) pathologic node negative [pN(-)] and 41 (6.7%) pathologic node positive [pN(+)] patients, diagnosed after complete surgical resection. The association between prognosis and pathologic findings was analyzed retrospectively. RESULTS: pN(+) patients had a significantly lower lepidic growth component ratio (10% vs 50%), a higher lymphatic invasion (LI) rate (68% vs 11%), vessel invasion rate (59% vs 14%), and visceral pleural invasion rate (29% vs 9%), compared with pN(-) patients (all Ps < .001). Surprisingly, 13 of 41 (32%) pN(+) patients showed no LI. In pN(-) patients, a multivariate analysis of recurrence-free survival revealed that lower lepidic growth component ratio, and lymphatic, vessel, and pleural invasion were significantly correlated with a poor prognosis (P = .008, .045, .031, and .024). However, in pN(+) patients, the multivariate analysis of recurrence-free survival showed that only LI was a significant independent prognostic factor (P = .037). The 5-year recurrence-free survival rates were as follows: 91.2% for pN(-)/LI(-) patients, 68.2% for pN(-)/LI(+) patients, 63.5% for pN(+)/LI(-) patients, and 41.9% for pN(+)/LI(+) patients. LI status stratified the prognosis not only in patients with no nodal metastasis but also in those with metastasis. CONCLUSIONS: LI, which is not always present in node-positive adenocarcinoma, is an important prognostic variable in patients with node involvement.