Factors associated with distant recurrence following R0 lobectomy for pN0 lung adenocarcinoma

Abstract

In patients undergoing R0 lobectomy with pN0 lung adenocarcinoma, pT stage and lymphovascular invasion were associated with distant recurrence and decreased DFS. These observations support the inclusion of these patients in future clinical trials investigating adjuvant targeted and immunotherapies.

Visiting an old foe: distant recurrence following R0 lobectomy for pathological N0 lung adenocarcinoma

“…found a 5-year cumulative incidence of distant recurrence of 14% and on multivariable analysis, demonstrated that large tumors sizes (pT2a and pT2b/3 tumors) were associated with distance recurrence and DFS (1). This makes intuitive sense and several existing studies corroborate these findings (6-8).…”

“…Lung cancer remains the leading cause of cancer-related death worldwide, with estimated 5-year survival rates for patients with pathological N0 (pN0) non-small cell lung cancer (NSCLC) as low as 56% (1,2). Although these staggering low survival rates could be attributed to a multitude of patient-related and tumor-related factors, recent evidence suggests that these outcomes are most likely related to tumor recurrence and metastasis (1,(3)(4)(5). In this regard, identification of clinically relevant predictors for tumor recurrence is an integral step towards improving patient prognosis, with a goal of defining a relevant patient cohort that would benefit from possible additional therapies (either induction or adjuvant therapy).…”

Risk stratification for distant recurrence of resected early stage non–small cell lung cancer is under construction

“…Finally, the 1.8% observed rate of local recurrence in this cohort (16/893) was also impressively low, in contrast to the 6% local recurrence reported in the Lung Cancer Study Group, in which the tumors were smaller than 5 cm. Brandt and colleagues 8 conclude that tumor size and lymphovascular invasion are independent predictors of recurrence.…”

Initial extended resection or neoadjuvant therapy for T4 non-small cell lung cancer—what is the evidence?

“…In the current 8 th edition of the TNM classification, T4 tumors are defined as T size >7 cm, tumors invading the mediastinum, heart, diaphragm, carina, trachea, great vessels, recurrent nerve, esophagus, or spine, or separate tumor nodule(s) in a different ipsilateral lobe (1). T4 tumors are frequently associated with mediastinal involvement, pleural dissemination, and extrathoracic metastasis (2)—all of which make T4 tumors less suitable for surgical resection. However, as more therapeutic options have become available, including neoadjuvant therapy, the role of surgery for these tumors has expanded.…”