Prediction for prognosis of resected pT1a-1bN0M0 adenocarcinoma based on tumor size and histological status: Relationship of TNM and IASLC/ATS/ERS classifications

Ito, Masaoki; Miyata, Yoshihiro; Kushitani, Kei; Yoshiya, Tomoharu; Mimae, Takahiro; Ibuki, Yuta; Misumi, Keizo; Takeshima, Yukio; Okada, Morihito

doi:10.1016/j.lungcan.2014.05.014

Cited by 38 publications

(29 citation statements)

References 21 publications

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“…AIS and MIA were first described in the IASLC/ATS/ERS classification 5 and are free from recurrence after complete resection. 28,29 They must be considered separate from invasive adenocarcinoma as so in the newly revised TNM staging: Tis (AIS) and T1a (mi) (MIA). 4 When evaluating recurrence risk in pN0M0 cases, it is important to exclude cases that are curable by complete resection.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of recurrence in resected EGFR‐positive pN0M0 invasive lung adenocarcinoma

et al. 2018

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BackgroundThis study was conducted to evaluate the prognostic and recurrent impact of EGFR mutation status in resected pN0M0 lung adenocarcinoma with consideration of the histological subtype.MethodsFollowing retrospective analysis of whole 474 consecutive pathological N0M0 lung adenocarcinoma patients, the prognostic significance of EGFR mutation status was evaluated in limited 394 subjects. Overall survival and recurrence‐free interval (RFI) were estimated using the Kaplan–Meier method and compared using a log‐rank test. Univariate and multivariate analyses were performed using Cox proportional hazard models.ResultsThe five‐year RFI was 85.7% and 93.3% for EGFR positive (n = 176) and negative (n = 218) cases, respectively (hazard ratio [HR] 1.992, 95% confidence interval [CI] 1.005–3.982; P = 0.048). Following the exclusion of specific subtypes free from recurrence or EGFR mutation (adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive mucinous adenocarcinoma), the five‐year RFI was obviously poorer in EGFR positive compared to negative cases (80.7% and 92.1%, respectively; HR 2.163, 95% CI 1.055–4.341; P = 0.035). Multivariate analysis excluding the specific subtypes confirmed that male sex, age, current or Ex‐smoking status, pleural invasion, and EGFR‐positive status were independently associated with shorter RFI. No significant differences in five‐year overall survival were found between the EGFR mutation positive and negative groups (88.7% and 93.7%, respectively; HR 1.630, 95% CI 0.787–3.432; P = 0.2).Conclusion EGFR mutations are associated with recurrence in pN0M0 lung adenocarcinoma. EGFR mutation status and histological subtype should be considered when evaluating the risk of recurrence in resected lung adenocarcinoma patients.

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Section: Discussionmentioning

confidence: 99%

Increased risk of recurrence in resected EGFR‐positive pN0M0 invasive lung adenocarcinoma

et al. 2018

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“…3-21 Seventeen studies demonstrated significant differences in patient outcomes among the histologic subtypes 3-12, 14, 15, 17-21 while only 2 studies did not. 13, 16 The survival rate for predominant histological subtypes and the outcome and the distribution of each histological subtypes is outlined in Figure 3 .…”

Section: Introductionmentioning

confidence: 99%

The New IASLC-ATS-ERS Lung Adenocarcinoma Classification: What the Surgeon Should Know

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Kadota

Park

et al. 2014

Seminars in Thoracic and Cardiovascular Surgery

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In 2011, a new histologic classification of lung adenocarcinomas was proposed from a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), based on the recommendation of an international and multidisciplinary panel. This classification proposed a method of comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary, and solid pattern) based on semi-quantitative assessment of histologic patterns (in 5% increments) with the ultimate goal of choosing a single, predominant pattern. Prognostic subsets could then be described for the classification. Patients with completely resected adenocarcinomas in situ (AIS) and minimally invasive adenocarcinomas (MIA) experienced low risk of recurrence. Patients with micropapillary or solid predominant tumors have a high risk for recurrence or cancer-related death. Patients with acinar and papillary predominant tumors comprise an intermediate-risk group. Herein, we review the outline of the proposed IASLC/ATS/ERS classification, a summary of published validation studies of this new classification and then discuss surgical key issues; we mainly focused on limited resection as an adequate treatment for early-stage lung adenocarcinomas as well as pre- and intraoperative diagnoses. We also review the published studies that identified the importance of histological subtypes in predicting recurrence, both rates and patterns, in early-stage lung adenocarcinomas. This new classification for the most common type of lung cancer is useful for surgeons, as its implementation would require only hematoxylin and eosin (H&E) histology slides, which is the common type of stain used in hospitals. It can be implemented with routine pathology evaluation and with no additional costs.

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“…Approximately 25% of cases detected at an early‐stage are candidates for surgical resection . Tumor size and nodal metastasis are well‐known prognostic factors in resected early‐stage lung ADC and one of the major factors that is considered in the treatment strategy. Additionally, given the advancing age of many patients diagnosed with lung ADC, there is a more prevalent risk for significant comorbidities in the aged population .…”

Section: Introductionmentioning

confidence: 99%

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

et al. 2019

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Recently, the incidence of small, peripheral lung adenocarcinoma has been increasing as lung cancer screening with radiologic examination is more widely performed. Tumor size is one of the determinants of the prognostic outcome in clinically node‐negative lung adenocarcinoma. Sublobar resection has been proposed as one of the minimally invasive surgical options for small‐sized adenocarcinomas. Despite the lack of robust clinical trial evidence, sublobar resection has become more popular, especially in developed countries where less extensive surgery may be of benefit in a population where the age of the elderly is growing. However, high risk histologic features such as micropapillary subtype and tumor spread through air space (STAS) have been associated with a significantly higher risk of local recurrence after sublobar resection, but not after lobectomy. Surgical decision‐making based on frozen section diagnosis of high risk histologic features may be useful to prevent local control failure after sublobar resection. At the present time, there is little evidence to demonstrate the diagnostic accuracy of identifying high risk histologic features on frozen section. One study has so far demonstrated that diagnostic accuracy of identifying STAS is higher than that of identifying the micropapillary subtype. Additionally, the presence of STAS has been found to be more strongly associated with local recurrence in patients who had undergone sublobar resection. Although further investigation is required for validation of this finding, STAS diagnosis on frozen section may shed further light on intraoperative surgical decision‐making during sublobar resection. To this end, we review the recently published data on the intraoperative identification of high risk features.

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Prediction for prognosis of resected pT1a-1bN0M0 adenocarcinoma based on tumor size and histological status: Relationship of TNM and IASLC/ATS/ERS classifications

Cited by 38 publications

References 21 publications

Increased risk of recurrence in resected EGFR‐positive pN0M0 invasive lung adenocarcinoma

Increased risk of recurrence in resected EGFR‐positive pN0M0 invasive lung adenocarcinoma

The New IASLC-ATS-ERS Lung Adenocarcinoma Classification: What the Surgeon Should Know

Challenges for real‐time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection

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