Prognostic and predictive value of the novel classification of lung adenocarcinoma in patients with stage IB

Luo, Jizhuang; Huang, Qingyuan; Wang, Rui; Han, Baohui; Zhang, Jie; Zhao, Heng; Fang, Wentao; Luo, Qingquan; Yang, Jun; Yang, Yunhai; Zhu, Lei; Chen, Tianxiang; Cheng, Xinghua; Wang, Yiyang; Zheng, Jie; Wu, Han; Xia, Weicong; Chen, Haiquan

doi:10.1007/s00432-016-2192-6

Cited by 38 publications

(41 citation statements)

References 29 publications

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“…A recent study [33] examined 928 patients with stage IB adenocarcinoma. The overall survival in this cohort was 87% and DFS was 73%.…”

Section: Predominant Pattern and Treatment Decisionsmentioning

confidence: 99%

Prognostic considerations of the new World Health Organization classification of lung adenocarcinoma

Borczuk

2016

Eur Respir Rev

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The 2015 World Health Organization (WHO) lung adenocarcinoma classification divides tumours into categories of indolent pre-invasive, minimally invasive and predominantly lepidic and, by examining predominant patterns of invasion, allows for further stratification into intermediate and highgrade tumours. The impact of the 2015 classification on prognosis was reviewed by a PubMed search for search terms "adenocarcinoma", "lung pathology" and "prognosis" and relevant publications reviewed. These were sorted for data on stage and survival as impacted by histological classification, and survival studies were separated into all stage versus stage 1 studies. Predictive aspects of histological classification were also examined, but molecular correlates were not. The separation of adenocarcinoma in situ and minimally invasive adenocarcinoma from invasive subtypes as distinct prognostic entities and the prognostic significance, for disease specific and overall survival for low-and high-grade categories, are discussed. The impact on stage at presentation including risk of node metastasis by histology is examined, as well as histology in relation to recurrence after surgery. Early data with regard to the value of predominant histology in the prediction of chemotherapy response will also be explored. @ERSpublications Lepidic lung ADC often early stage and indolent; solid and micropapillary tumours often metastatic and recurrent http://ow.ly/DCiT305xExK

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“…A recent study [33] examined 928 patients with stage IB adenocarcinoma. The overall survival in this cohort was 87% and DFS was 73%.…”

Section: Predominant Pattern and Treatment Decisionsmentioning

confidence: 99%

Prognostic considerations of the new World Health Organization classification of lung adenocarcinoma

Borczuk

2016

Eur Respir Rev

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“…Positron emission tomography (PET) scans were recommended for patients with suspicious hilum or mediastinal lymph node enlargement. The postsurgical surveillance was performed as previously described (19,20): chest CT and neck and upper abdominal ultrasound examinations were performed every 3 months for the first …”

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confidence: 99%

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

et al. 2018

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Background: This study aimed to evaluate the prognostic difference between limited resection and lobectomy among elderly patients with small size lung adenocarcinoma. Methods: A total of 666 patients >65 years old with stage I lung adenocarcinoma and tumor size ≤2 cm were included. The patient survival was evaluated by disease-free survival (DFS) and overall survival (OS). Results: No DFS or OS advantage was found between the lobectomy and wedge resection groups when tumor sizes were ≤1 cm (DFS, P=0.112; OS, P=0.294). The wedge resection group had a significantly worse OS (P=0.041) than that in the lobectomy group when tumor sizes were >1 cm and ≤2 cm. Conclusions: We conclude that wedge resection may be a reasonable surgical choice for elderly patients with tumor sizes ≤1 cm. The International Association Study of Lung Cancer (IASLC), the American Thoracic Society (ATS) and the European Respiratory Society (ERS) proposed a new edition of the lung adenocarcinoma classification system in 2011 (12). It has been effectively used to predict the prognosis of lung adenocarcinoma patients. The classification was established on the most predominant subtype presented: invasive adenocarcinoma with solid (SOL) or micropapillary (MIP) carcinoma, which is associated with a poor survival (13)(14)(15)(16)(17). Both adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have nearly 100% postsurgical survival, and limited resection is appropriate for those patients. However, to date, whether limited resection is adequate for early-stage invasive lung adenocarcinoma patients, especially for patients who are older than 65, has not been thoroughly studied (8). In this study, a large cohort investigation was carried out to determine the correlation between surgical procedures and postoperative survival among elderly lung adenocarcinoma patients with tumor sizes ≤2 cm. Our study may help to design personalized surgical strategies for older patients. Methods Patient cohortThe retrospective study was permitted by the Institutional Review Board of Shanghai Chest Hospital at Shanghai Jiao Tong University and was performed in compliance with the guidelines of clinical research [ethic approval ID: KS(P)1802].We retrospectively reviewed patients who underwent surgical resection at our hospital between January 2009 and March 2015. The inclusion criteria were patients 65 years old or older, presentation of a single lung nodule, the postsurgical pathological specimen examination validated that the tumor size was less than or equal to 2 cm, there was no lymph node invasion, and there was no distant organ metastasis. The exclusion criteria included patients who had a history of malignancy, had multiple nodules, received neoadjuvant chemotherapy AIS or MIA. Invasive adenocarcinoma variants (such as mucinous, enteric or fetal morphologies) were also excluded for low incidence. Finally, this study included a total of 666 patients.In our clinical practice, patients with the following characteristics were treated with limited resect...

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“…Although several previous studies have reported poor prognosis of solid tumors in stage IB postoperative recovery and suggested ACT for this population, direct evidence regarding the prognosis of solid predominant versus solid non‐predominant tumor types is limited, and no direct proof regarding the effect of ACT in these two groups has been found . Therefore, we believe our results provide important novel insights into the clinical relevance of this treatment.…”

Section: Discussionmentioning

confidence: 70%

“…Furthermore, the NCCN guidelines have been updated for patients with high risk factors in stage IB adenocarcinoma, such as tumor size > 4 cm, visceral pleural invasion, lymph‐vascular invasion, poorly differentiated tumors, wedge resection, or incomplete lymph node sampling . After publication of the IASLC/ATS/ERS classification, the relationship between pathological subtypes and the prognosis of recurrence has drawn considerable attention . In an American cohort of 240 subjects, Solis et al .…”

Section: Discussionmentioning

confidence: 99%

Value of adjuvant chemotherapy in patients with resected stage IB solid predominant and solid non‐predominant lung adenocarcinoma

Cao

Teng

et al. 2018

Thoracic Cancer

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BackgroundThe use of adjuvant chemotherapy (ACT) for stage IB lung adenocarcinoma remains controversial. We examined the benefits of ACT in stage IB patients with tumors composed of solid material.MethodsThe records of 309 patients with stage IB lung adenocarcinoma who had undergone complete resection between 2006 and 2015 were reviewed. All pathological slides were evaluated for the composition of solid material.ResultsOur data showed that although disease‐free survival (DFS) and overall survival (OS) were not significantly different (P = 0.306 and P = 0.061, respectively) between patients displaying a solid pattern of tumor growth and treated with or without ACT, patients with a solid predominant pattern of tumor growth treated with ACT had longer DFS (hazard ratio 0.359; P = 0.033) and OS (hazard ratio 0.205; P = 0.003). In patients with solid non‐predominant patterns, treatment with ACT had no effect on DFS (P = 0.326) or OS (P = 0.508).ConclusionsPostoperative patients with the solid predominant pattern of stage IB lung adenocarcinoma may benefit from ACT, while those with the solid non‐predominant pattern will not.

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Prognostic and predictive value of the novel classification of lung adenocarcinoma in patients with stage IB

Abstract: SOL/MIP predominant pattern was predictive for ACT benefit for DFS among invasive lung adenocarcinoma patients in stage IB.

Cited by 38 publications

References 29 publications

Prognostic considerations of the new World Health Organization classification of lung adenocarcinoma

Prognostic considerations of the new World Health Organization classification of lung adenocarcinoma

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

Value of adjuvant chemotherapy in patients with resected stage IB solid predominant and solid non‐predominant lung adenocarcinoma

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