Aritoshi Hattori1, Takeshi Matsunaga1, Kazuya Takamochi1, Shiaki Oh1, Kenji Suzuki2. 1. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 2. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: kjsuzuki@juntendo.ac.jp.
Abstract
OBJECTIVES: The aim of this study was to identify clinical factors associated with lepidic growth in resected clinical stage IA radiologic pure-solid lung adenocarcinoma for identifying a possible sublobar resection candidate in the population. METHODS: Clinicopathologic data were reviewed for 200 surgically resected clinical stage IA pure-solid lung adenocarcinomas. Radiologic pure-solid tumor was defined as a tumor without a ground-glass opacity component, that is, a consolidation tumor ratio equal to 1.0. Lepidic predominant adenocarcinoma included adenocarcinomas in situ, minimally invasive adenocarcinomas, and lepidic predominant invasive adenocarcinomas. RESULTS: A total of 57 patients (29%) had lepidic predominant adenocarcinoma. The 5-year overall survival of clinical stage IA pure-solid adenocarcinoma was 83.4% and that of lepidic predominant adenocarcinoma and nonlepidic predominant adenocarcinoma was 98.1% versus 76.6% (P = .0012). A multivariate analysis revealed that maximum standardized uptake value was an independently significant variable of lepidic predominant adenocarcinoma (P < .0001) and a significant prognostic factor (P = .034). The predictive criterion of lepidic predominant adenocarcinoma was maximum standardized uptake value 3.3 or less based on a receiver operating characteristic curve, and 77 patients (39%) who met this criterion showed less pathologic invasiveness regarding lymphatic (P = .0012) and vascular (P < .0001) invasions, nodal metastasis (P = .0007), and better overall survival than those who did not (maximum standardized uptake value ≤3.3 vs >3.3 rates being 91.7% vs 78.6%, P = .0031). Moreover, the 3-year locoregional recurrence-free survival of the sublobar resection arm was significantly worse than that of the lobectomy arm when the tumor showed maximum standardized uptake value greater than 3.3 (62.7% vs 82.9%, P = .0281). CONCLUSIONS: Higher maximum standardized uptake value may be useful for identifying patients with clinical stage IA radiologic pure-solid lung adenocarcinoma in whom sublobar resection should not be considered, even if technically feasible.
OBJECTIVES: The aim of this study was to identify clinical factors associated with lepidic growth in resected clinical stage IA radiologic pure-solid lung adenocarcinoma for identifying a possible sublobar resection candidate in the population. METHODS: Clinicopathologic data were reviewed for 200 surgically resected clinical stage IA pure-solid lung adenocarcinomas. Radiologic pure-solid tumor was defined as a tumor without a ground-glass opacity component, that is, a consolidation tumor ratio equal to 1.0. Lepidic predominant adenocarcinoma included adenocarcinomas in situ, minimally invasive adenocarcinomas, and lepidic predominant invasive adenocarcinomas. RESULTS: A total of 57 patients (29%) had lepidic predominant adenocarcinoma. The 5-year overall survival of clinical stage IA pure-solid adenocarcinoma was 83.4% and that of lepidic predominant adenocarcinoma and nonlepidic predominant adenocarcinoma was 98.1% versus 76.6% (P = .0012). A multivariate analysis revealed that maximum standardized uptake value was an independently significant variable of lepidic predominant adenocarcinoma (P < .0001) and a significant prognostic factor (P = .034). The predictive criterion of lepidic predominant adenocarcinoma was maximum standardized uptake value 3.3 or less based on a receiver operating characteristic curve, and 77 patients (39%) who met this criterion showed less pathologic invasiveness regarding lymphatic (P = .0012) and vascular (P < .0001) invasions, nodal metastasis (P = .0007), and better overall survival than those who did not (maximum standardized uptake value ≤3.3 vs >3.3 rates being 91.7% vs 78.6%, P = .0031). Moreover, the 3-year locoregional recurrence-free survival of the sublobar resection arm was significantly worse than that of the lobectomy arm when the tumor showed maximum standardized uptake value greater than 3.3 (62.7% vs 82.9%, P = .0281). CONCLUSIONS: Higher maximum standardized uptake value may be useful for identifying patients with clinical stage IA radiologic pure-solid lung adenocarcinoma in whom sublobar resection should not be considered, even if technically feasible.