Hiroyuki Ito1, Haruhiko Nakayama2, Shuji Murakami3, Tomoyuki Yokose4, Kayoko Katayama5, Yoshihiro Miyata6, Morihito Okada6. 1. Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan. h-ito@kcch.jp. 2. Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan. 3. Department of Thoracic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan. 4. Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan. 5. Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan. 6. Department of Thoracic Surgery, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-0037, Japan.
Abstract
OBJECTIVES: We studied whether histologic subtype according to the new IASLC/ATS/ERS adenocarcinoma classification influences the extent of resection in patients with pathological stage IA lung adenocarcinoma. METHODS: Data on 288 patients with pathological stage IA lung adenocarcinoma were analyzed retrospectively. Recurrence-free survival (RFS) rates were compared according to clinicopathological characteristics, including predominant histologic subtype and extent of resection. RESULTS: Median follow-up was 38.9 months. Lobectomy was performed in 146 patients, and sublobar resection in 142 patients. When recurrence was compared among the low-grade group (adenocarcinoma in situ, AIS; minimally invasive adenocarcinoma, MIA), intermediate-grade group (lepidic, acinar, and papillary) and high-grade group (solid and micropapillary), the RFS rate decreased as the grade increased (p = 0.037). There was no recurrence in the low-grade or lepidic predominant groups. The recurrence pattern did not differ according to the type of resection or histological subtype. Even in the intermediate- and high-grade groups, the extent of resection was not significantly related to the RFS rate (p = 0.622, p = 0.516). The results were unchanged after adjusting for independent risk factors. The concordance rate between clinical and pathological stage IA was good in low (98.6%) and intermediate grade (84.6%) and poor in high grade (41.2%). CONCLUSIONS: AIS, MIA, and lepidic predominant may be curable by any type of complete resection. Even in invasive subtypes, lobectomy does not offer a recurrence-free advantage over sublobar resection. However, in the high-grade group, less than half of clinical stage IA was actually pathological stage IA. Physicians should exercise caution whenever sublobar resection is planned.
OBJECTIVES: We studied whether histologic subtype according to the new IASLC/ATS/ERS adenocarcinoma classification influences the extent of resection in patients with pathological stage IA lung adenocarcinoma. METHODS: Data on 288 patients with pathological stage IA lung adenocarcinoma were analyzed retrospectively. Recurrence-free survival (RFS) rates were compared according to clinicopathological characteristics, including predominant histologic subtype and extent of resection. RESULTS: Median follow-up was 38.9 months. Lobectomy was performed in 146 patients, and sublobar resection in 142 patients. When recurrence was compared among the low-grade group (adenocarcinoma in situ, AIS; minimally invasive adenocarcinoma, MIA), intermediate-grade group (lepidic, acinar, and papillary) and high-grade group (solid and micropapillary), the RFS rate decreased as the grade increased (p = 0.037). There was no recurrence in the low-grade or lepidic predominant groups. The recurrence pattern did not differ according to the type of resection or histological subtype. Even in the intermediate- and high-grade groups, the extent of resection was not significantly related to the RFS rate (p = 0.622, p = 0.516). The results were unchanged after adjusting for independent risk factors. The concordance rate between clinical and pathological stage IA was good in low (98.6%) and intermediate grade (84.6%) and poor in high grade (41.2%). CONCLUSIONS: AIS, MIA, and lepidic predominant may be curable by any type of complete resection. Even in invasive subtypes, lobectomy does not offer a recurrence-free advantage over sublobar resection. However, in the high-grade group, less than half of clinical stage IA was actually pathological stage IA. Physicians should exercise caution whenever sublobar resection is planned.
Entities:
Keywords:
Adenocarcinoma; Lung cancer; Pathological stage IA; Predominant subtype; Surgery
Authors: Valerie W Rusch; Debra Hawes; Paul A Decker; Sue Ellen Martin; Andrea Abati; Rodney J Landreneau; G Alexander Patterson; Richard I Inculet; David R Jones; Richard A Malthaner; Robbin G Cohen; Karla Ballman; Joe B Putnam; Richard J Cote Journal: J Clin Oncol Date: 2011-10-11 Impact factor: 44.544