Solid predominant histologic subtype and early recurrence predict poor postrecurrence survival in patients with stage I lung adenocarcinoma

Abstract

IntroductionThis study investigated the correlation between histologic predominant pattern and postrecurrence survival (PRS), and identified the clinicopathologic factors influencing PRS in patients with completely resected stage I lung adenocarcinoma.MethodsA total of 136 stage I lung adenocarcinoma patients who experienced tumor recurrence after completely resection were included in this study. To analysis the association between histologic predominant pattern and PRS, invasive adenocarcinomas with mixed histologic components were divided into 2 groups: solid and nonsolid group (including lepidic, acinar, papillary, micropapillary) based on the histologic predominant pattern. PRS was analyzed to identify the prognostic predictors using the Kaplan-Meier approach and multivariable Cox models.ResultsFor all stage I invasive adenocarcinoma patients, the majority of postsurgical recurrences occurred within 2 years. Patients with solid predominant histological pattern were associated with unfavorable PRS (HR, 2.40; 95%CI 1.13-5.08, p=.022). There was a significant difference for poor PRS for patients who diagnosed tumor recurrence shorter than 12 months after surgery (HR, 2.34; 95%CI 1.12-4.90, p=.024). Extrathoracic metastasis was associated with poor media PRS in univariable analysis (p =.011), however, there was no significant PRS difference in multivariable analysis (HR, 1.56; 95%CI 0.65-3.73, p=.322) compared with intrathoracic metastasis.ConclusionsSolid predominant histologic subtype and recurrence free interval less than 12 months predict worse PRS in patients with stage I lung adenocarcinoma.

Microwave Ablation in Primary Lung Malignancies

“…40 This is similar to the data from the surgical literature, which showed that solid predominant histologic subtype was one of the factors associated with poorer recurrence-free survival. 41 The implications of this finding regarding subtypes of other NSCLCs is unknown, but reinforces the importance of histopathologic evidence prior to treatment as opposed to relying on imaging diagnosis of NSCLC. 42 Regarding overall survival, a meta-analysis of 53 studies of RFA and MWA in primary and secondary lung tumors showed a median survival time of 24.4 months in a subgroup analysis focusing mainly on MWA in primary lung tumors.…”

Impact of Solid Minor Histologic Subtype in Postsurgical Prognosis of Stage I Lung Adenocarcinoma

“…Our previous study reported that solid predominant pattern was associated with unfavorable postrecurrence survival, especially for patients who had tumor recurrence within 12 months after surgery [23]. Stage IB patients with solid/micropapillary predominant pattern could benefit from adjuvant chemotherapy for a better DFS.…”

The Clinical Impact of Solid and Micropapillary Patterns in Resected Lung Adenocarcinoma: Author's Reply

“…2 In particular, the median OS of 13.5 months (95% confidence interval 5.7-21.2) in our series was comparable to that reported by Chao et al, but after a notably longer median FU of 19.3 months. We also concluded that smaller tumors had better outcomes and observed a median OS of 17.4 months in patients with a planning target volume less than 300 cm 3 . In an updated report of 30 such patients after a median FU of 25 months, the median OS remained unchanged.…”

“…In an updated report of 30 such patients after a median FU of 25 months, the median OS remained unchanged. 3 Six patients who underwent a central retreatment died of hemorrhage at a median of 7 months after treatment. The currently available results do not suggest a clear difference between photon and proton reirradiation, and for the patients with the highest risk, centrally located organs such as large airways and vessels are typically in contact with the tumor and inside the volume to be retreated, thus limiting the high-dose sparing that can be expected even with the use of protons.…”