Solid Predominant Histologic Subtype in Resected Stage I Lung Adenocarcinoma Is an Independent Predictor of Early, Extrathoracic, Multisite Recurrence and of Poor Postrecurrence Survival

Abstract

A B S T R A C T PurposeTo examine the significance of the proposed International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) histologic subtypes of lung adenocarcinoma for patterns of recurrence and, among patients who recur following resection of stage I lung adenocarcinoma, for postrecurrence survival (PRS). Patients and MethodsWe reviewed patients with stage I lung adenocarcinoma who had undergone complete surgical resection from 1999 to 2009 (N ϭ 1,120). Tumors were subtyped by using the IASLC/ATS/ERS classification. The effects of the dominant subtype on recurrence and, among patients who recurred, on PRS were investigated. ResultsOf 1,120 patients identified, 188 had recurrent disease, 103 of whom died as a result of lung cancer. Among patients who recurred, 2-year PRS was 45%, and median PRS was 26.1 months. Compared with patients with nonsolid tumors, patients with solid predominant tumors had earlier (P ϭ .007), more extrathoracic (P Ͻ .001), and more multisite (P ϭ .011) recurrences. Multivariable analysis of primary tumor factors revealed that, among patients who recurred, solid predominant histologic pattern in the primary tumor (hazard ratio [HR], 1.76; P ϭ .016), age older than 65 years (HR, 1.63; P ϭ .01), and sublobar resection (HR, 1.6; P ϭ .01) were significantly associated with worse PRS. Presence of extrathoracic metastasis (HR, 1.76; P ϭ .013) and age older than 65 years at the time of recurrence (HR, 1.7; P ϭ .014) were also significantly associated with worse PRS. ConclusionIn patients with stage I primary lung adenocarcinoma, solid predominant subtype is an independent predictor of early recurrence and, among those patients who recur, of worse PRS. Our findings provide a rationale for investigating adjuvant therapy and identify novel therapeutic targets for patients with solid predominant lung adenocarcinoma.

Cell cycle progression score is a marker for five-year lung cancer-specific mortality risk in patients with resected stage I lung adenocarcinoma

“…In patients with the SOL predominant subtype, who we reported have early, extrathoracic, and multisite recurrences and poor postrecurrence survival [7], 17% of patients (25/147) had low mPS, compared with 83% with high mPS. There was also strong evidence of an increasing proportion of high mPS with increasing percentage of SOL component, in all patient cohorts.…”

“…The use of this well-annotated, previously reported cohort allowed us to assess the prognostic ability of all known clinical, surgical, pathological, histological, and molecular features indicative of aggressiveness—which included lymphatic and vascular invasion [4], type of surgical procedure [7, 19], histological subtypes (defined in the IASLC/ATS/ERS classification) [3, 7, 19], and EGFR and KRAS mutation status [20]. This expansive analysis, inclusive of all known high-risk factors, demonstrated that CCP score and mPS are independent prognostic markers for patients with stage I lung ADC.…”

Image-guided thoracic surgery in the hybrid operation room

“…One of the key goals of the GTx surgery program is to fund and support research for early tumor detection, when tumors are at their smallest and most treatable stages (14). Innovations within the GTx Lab led to the development of a transportable, intra-operative CBCT that has been established in prospective clinical trials for head and neck surgery in our institution (15).…”

Surgical pathology of early stage non-small cell lung carcinoma

“…Furthermore, as these tumors tend to be EGFR negative and KRAS positive, they are not amenable to molecular targeting. For this cohort of patients, adjuvant therapeutic strategies require investigation (41).…”