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Background: Although T factor is defined as the size of invasive area rather than total tumor size in the eighth edition of the TNM classification, whether the pathological invasive area to tumor ratio (ITR) is a prognostic factor has not yet been evaluated. Methods: In total, 432 lung adenocarcinoma patients were analyzed, among which 266 patients with pathological stage IA were used to perform a subanalysis. Results: Smoking status (odds ratio [OR]: 0.43, p = 0.01), neutrophil-to-lymphocyte ratio (NLR) (OR: 1.97, p = 0.03), maximum standardized uptake value (SUV max ) (OR: 3.62, p < 0.01), and ITR (OR: 6.76, p < 0.01) were significantly different in univariate analysis. Smoking status (OR: 0.34, p < 0.01), SUV max (OR: 3.05, p < 0.01), and ITR (OR: 5.44, p < 0.01) were risk factors for recurrence in multivariate analysis. In patients with pathological stage IA disease, smoking status (OR: 0.34, p = 0.03), NLR (OR: 2.30, p = 0.04), SUV max (OR: 3.63, p < 0.01), pathological invasive area (OR: 4.00, p < 0.01), and ITR (OR: 6.03, p < 0.01) were significantly different in univariate analysis. Smoking status (OR: 0.27, p = 0.02), SUV max (OR: 3.93, p < 0.01), and ITR (OR: 4.38, p < 0.01) were significant risk factors for recurrence in multivariate analysis. Conclusions: SUV max and ITR are risk factors for recurrence. These results suggest that SUV max is important for deciding the indication for limited resection or adjuvant chemotherapy, and ITR is an adaptation criterion for adjuvant chemotherapy for early-stage lung adenocarcinoma patients. K E Y W O R D Searly stage, invasive area to tumor ratio, non-small cell lung cancer, standardized uptake value

Background Although the consolidation diameter of a tumor on computed tomography (CT) is an adaptation criterion for limited resection in early-stage non-small cell lung cancer (NSCLC), whether the maximum standardized uptake value (SUVmax) is also an adaptation criterion for limited resection has not been evaluated. Methods In total, 478 NSCLC patients with clinical stage IA disease were analyzed, among whom 383 were used to perform a sub-analysis. Results Multivariate analysis showed that consolidation diameter (odds ratio [OR]: 3.05, p = 0.01), SUVmax (OR: 10.74, p = 0.02), and lymphatic invasion (OR: 10.34, p < 0.01) were risk factors for lymph node metastasis in clinical stage IA NSCLC patients. Furthermore, age (OR: 2.98, p = 0.03), SUVmax (OR: 13.07, p = 0.02), and lymphatic invasion (OR: 5.88, p = 0.02) were risk factors for lymph node metastasis in clinical stage IA lung adenocarcinoma patients according to multivariate analysis. Conclusions Consolidation diameter of a tumor on CT, SUVmax, and lymphatic invasion are risk factors for lymph node metastasis. These results suggest that for early-stage lung adenocarcinoma patients, SUVmax is more important for deciding the indication of limited resection.

Purpose: Although targeting programmed death-1 (PD-1) and its ligand, programmed death-ligand 1 (PD-L1), is an established treatment modality for non-small cell lung cancer (NSCLC), the prognostic relevance of PD-L1 expression in NSCLC patients who undergo pulmonary resection is controversial. Methods: Two hundred thirty-seven NSCLC patients who underwent pulmonary resection were enrolled and the relationship between PD-L1 and various clinicopathological factors, as well as the prognostic relevance of PD-L1, was evaluated. Results: PD-L1 expression was significantly higher in male patients (p<0.01), lymphatic invasion (p<0.01), vascular invasion (p<0.01), grade 3–4 differentiation (p<0.01), squamous cell carcinoma (p<0.01), and pathological stage >II (p<0.01), but significantly lower in those who were epithelial growth factor receptor (EGFR) mutation-negative (p<0.01). Relapse-free survival was significantly worse in patients with PD-L1 expression (p=0.04). Univariate analysis showed that male sex (p=0.04), carcinoembryonic antigen expression (CEA) (p<0.01), maximum standardized uptake value (p<0.01), lymphatic invasion (p<0.01), vascular invasion (p<0.01), grade 3–4 differentiation (p<0.01), lower lobe disease (p=0.04), PD-L1 expression (p=0.03), and pathological stage (p<0.01) were significant risk factors of recurrence. In multivariate analysis, CEA expression (p=0.01), lymphatic invasion (p=0.04), and pathological stage (p<0.01) were risk factors for recurrence, whereas PD-L1 expression was not a significant factor of recurrence (p=0.62). Conclusion: PD-L1 expression was not a risk factor of recurrence but tumor progression tended to increase PD-L1 expression. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients

Background The relative efficacies of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and immune checkpoint inhibitors (ICIs) for the treatment of recurrent non-small cell lung cancer (NSCLC) after surgery remain unclear. Methods Among 801 patients with NSCLC who underwent pulmonary resection at Kanazawa Medical University between 2017 and 2021, 64 patients had recurrence. We retrospectively compared the efficacies of EGFR-TKIs and ICIs in these patients with recurrent NSCLC who underwent pulmonary resection. Results The 3-year overall survival rates after recurrence were 79.3% in patients who received EGFR-TKIs, 69.5% in patients who received ICIs, and 43.7% in patients who received cytotoxic agents. There was no significant difference in overall survival between patients treated with EGFR-TKIs and ICIs (p = 0.14) or between patients treated with ICIs and cytotoxic agents (p = 0.23), but overall survival was significantly higher in patients treated with EGFR-TKIs compared with cytotoxic agents (p < 0.01) The probabilities of a 2-year response were 88.5%, 61.6%, and 25.9% in patients treated with EGFR-TKIs, ICIs, and cytotoxic agents, respectively. There was no significant difference in response periods between patients treated with EGFR-TKIs and ICIs (p = 0.18), but the response period was significantly better in patients treated with EGFR-TKIs (p < 0.01) or ICIs (p = 0.03) compared with cytotoxic agents. Percent-predicted vital capacity (p = 0.03) and epidermal growth factor receptor gene mutation (p < 0.01) were significant factors affecting the overall response to chemotherapy in multivariate analysis. Conclusion EGFR-TKIs and ICIs are effective for treating recurrent NSCLC after surgery. Although adjuvant chemotherapy for completely resected pathological stage II to IIIA NSCLC, atezolizumab or osimertinib, has also been recently approved as adjuvant chemotherapy, there is a risk that patients who relapse after adjuvant chemotherapy will have less choice.

Background Several risk factors for postoperative recurrence of spontaneous pneumothorax have been reported, but the identified risk factors differed among studies. Methods A total of 272 spontaneous pneumothorax patients were enrolled in this retrospective study, and the risk factors for postoperative recurrence were evaluated. Results Among the patients, more than 80% with ipsilateral postoperative recurrence relapsed within 3 years and more than 80% with contralateral postoperative recurrence relapsed within 4 years. Univariate analyses showed that age < 25 years (p < 0.01), Brinkman index = 0 (p = 0.03), intraoperative adhesion (p = 0.04), and upward lung volume > 75.8% (p = 0.03) were significant risk factors for ipsilateral postoperative recurrence. Age < 25 years (odds ratio: 10.41; 95% confidence interval: 1.42–76.15; p = 0.02) and intraoperative adhesion (odds ratio: 10.18; 95% confidence interval: 2.39–43.22; p < 0.01) were identified as risk factors for ipsilateral postoperative recurrence in a multivariate analysis. Conclusions The present findings suggest that young age and intraoperative adhesion are risk factors for postoperative recurrence of spontaneous pneumothorax. For such patients, additional intraoperative procedures, such as covering with polyglycolic acid sheet for primary spontaneous pneumothorax and covering with absorbable oxidized cellulose with 50% glucose solution, may be required to reduce postoperative recurrence. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I800), and written informed consent was obtained from all patients