AimsAlthough it is necessary to measure the invasive size of lung adenocarcinoma with a lepidic component, it is not uncommon to have trouble in measuring the invasive size of lung adenocarcinoma. This study examined whether there were other stronger prognostic factors than invasive size.MethodsWe characterised the clinicopathological features associated with recurrence-free survival (RFS) of 686 patients with the pathological stage (p-Stage) I lung adenocarcinoma. Moreover, we compared the area under the curve (AUC) values for recurrence between various combinations of pathological-baseline (age & sex & p-Stage based on invasive size) (B(i)) and several prognostic factors, and various combinations of p-baseline based on total tumour size (B(t)) and several prognostic factors.ResultsAUC showed no significant differences between B(i) & new International Association for the Study of Lung Cancer grade (G) or vascular invasion (V), and B(t) & G or V. AUC was the highest in B & G & lymphatic invasion (L) & V. RFS was significantly shorter in patients with G3 OR L(+) OR V(+) than in those with G≤2 AND L(-) AND V(-) in each p-Stage based on invasive size (p-Stage(i)) and p-Stage based on total tumour size (p-Stage(t)) (p<0.05), and there were no significant differences in RFS between each p-Stage(i) and p-Stage(t).ConclusionsIn any invasive size or total tumour size of p-Stage I lung adenocarcinoma, G, L and V are more powerful prognostic factors than the size criteria of p-Stage. Therefore, pathologists should focus on these pathological findings.

Background Although the opportunity to treat subcentimeter lung cancers has increased, the optimal surgical methods remain unclear. We performed a retrospective study to examine the clinical outcome of subcentimeter lung cancers. Patients and Methods In total, 118 patients who underwent curative resection for subcentimeter lung cancer from January 2005 to December 2013 were analyzed. Multivariate Cox proportional hazards models were used to calculate the hazard ratio to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS). Results Anatomical resections were performed for 64 patients (59 lobectomies and 5 segmentectomies) and wedge resections for 54 patients. Recurrence developed in six patients who had consolidation-predominant tumors (consolidation/tumor [C/T] ratio of >0.5) and underwent wedge resections. The first recurrence patterns were regional recurrences in three patients, both regional and distant in one, and distant in two. Seventeen patients died of other causes. The multivariate analysis revealed that the C/T ratio was the independent predictor of RFS (p = 0.008) and OS (p = 0.011). Conclusion Patients with subcentimeter lung cancer rarely developed recurrence. The C/T ratio was the independent prognostic factor, and all relapsed patients received wedge resections. Even for subcentimeter lung cancers, we should select the extent of pulmonary resection after thoroughly considering whether wedge resection (less invasiveness) is a reasonable alternative to anatomical resection (superior oncologic efficacy) considering the C/T ratio of the lesion.

Background/Aim: We investigated the relationship between solid component size (SS), carcinoembryonic antigen (CEA), and standardized uptake value (SUVmax) as continuous variables and postoperative clustered circulating tumor cell (C-CTC) detection in patients with pulmonary adenocarcinoma who underwent surgery. Patients and Methods: C-CTC detection was the main evaluation item, which was analyzed using the receiver operating characteristic curve to calculate areas under the curves (AUCs) for the variables. Additionally, the two-year recurrence-free survival rates (2Y-RFSRs) were analyzed. Results: Among the 84 patients examined, SS, CEA, and SUVmax had AUCs>0.7, and were independent. Their thresholds were 2.1 cm, 7.5 ng/ml, and 2.9, respectively. The 2Y-RFSR were significantly better in the non-C-CTC group (n=58) and in the group of patients without high levels of these predictors (n=32). Conclusion: SS, CEA level, and SUVmax predicted postoperative CTC detection in pulmonary adenocarcinoma patients.

Background/Aim: Vein-first lobectomy (VFL) in lung cancer might reduce shedding of circulating tumour cells (CTCs). This study assessed the clinical significance of VFL. Patients and Methods: Lung cancer patients undergoing lobectomy and CTC testing were evaluated. The primary evaluation item was postoperative clustered CTC detection, and the secondary outcome measures were the 2-year overall survival and recurrence-free survival rates according to the status of VFL and postoperative clustered CTC. Results: Eighty-six patients with similar backgrounds, except for lobe resection and pulmonary vein dissection time, showed postoperative clustered CTC identification rates of 43.8% and 37.9% in the VFL group (n=57) and no-VFL group (n=29), respectively. However, prognosis was not significantly different, although the presence of clustered CTC after surgery was a predictor of recurrence. Conclusion: The status of postoperative clustered CTC was similar regardless of VFL or not, although the detection of clustered CTC was a predictor of recurrence.

Background: Vein-first dissecting lobectomy in lung cancer surgery is speculated to limit the amount of circulating tumor cells. We aimed to assess the clinical significance and prognostic impact of Vein-first dissecting lobectomy according to changes in circulating tumor cell status throughout the perioperative period.Methods: Among patients with pulmonary nodule who underwent surgery, we extracted and evaluated patients who underwent lobectomy for lung cancer and had underwent circulating tumor cell testing before and immediately after the completion of lobectomy. The primary evaluation item was the detection rate of postoperative circulating tumor cell according to the sequence of pulmonary vessel processing. The secondary evaluation items were the 2-year recurrence-free survival and overall survival rates according to the status of Vein-first dissecting lobectomy and postoperative circulating tumor cell. Results: Between June 2014 and June 2018, 302 patients with pulmonary nodule underwent surgery, among them we selected 86 patients who underwent lobectomy for lung cancer and had circulating tumor cell testing done before and immediately after the completion of lobectomy. The circulating tumor cell identification rates in the postoperative period were 54.4% (37/68) and 66.7% (12/18) (p=0.8) in vein-first dissecting lobectomy group and no-vein-first dissecting lobectomy group, respectively. The mean postoperative circulating tumor cell count was not significantly different between the vein-first dissecting lobectomy and no-vein-first dissecting lobectomy groups (3.0 ± 3.6 vs 3.2 ± 5.0, p=0.8). The 2-year recurrence-free survival and overall survival rates were also not significantly different. However, the presence of circulating tumor cell after surgery was a predictor of recurrence.Conclusions: Although the detection of circulating tumor cell after surgery is a predictor of cancer recurrence, no significant difference was observed in the status of postoperative circulating tumor cell s between vein-first dissecting lobectomy and no- vein-first dissecting lobectomy groups in lung cancer surgery.