Risk of recurrence in stage I adenocarcinoma of the lung: a multi-institutional study on synergism between type of surgery and type of nodal staging

Abstract

Background: In last years, an increasing interest emerges on the role of sub-lobar resection and lobespecific lymph nodal dissection in the treatment of early-stage lung cancer. The aim of our study was to define the impact on cumulative incidence of recurrence (CIR) of type of surgical resection and type of nodal staging in this subset of patients. Furthermore, we evaluated the possible synergism between the different kinds of procedure. Methods: An analysis of 969 consecutive stage I pulmonary adenocarcinoma patients, operated in six Thoracic Surgery Institutions between 2001 and 2013, was conducted. Type of surgical resection included lobectomy and sub-lobar resection; while pneumonectomy and bilobectomy were excluded from the analysis. Nodal staging procedures were classified in nodal sampling (NS), lobe-specific lymph node dissection (LS-ND) and systematic lymph node dissection (SND). Multivariable-adjusted comparisons for CIR was performed using Fine and Grey model, taking into account of death by any cause as competing event. In order to evaluate synergism between the different procedures, the test of interaction between type of surgical resection and type of nodal staging was carried out and results presented in a stratified way. Results: Eight-hundred forty-six (87%) patients were submitted to lobectomy, while 123 (13%) to sublobar resection. Four-hundred fifty-five (47%) patients received SND, 98 (10%) LS-ND and 416 (43%) NS. Two-hundred forty-seven (26%) patients developed a local/distant recurrence with a 5-year CIR of 24.2%. Multivariable-adjusted comparisons showed an independent negative effect of sub-lobar resection (HR =1.52; 95% CI: 1.07-2.17), LS-ND (HR =1.74; 95% CI: 1.16-2.6) and NS (HR =1.49; 95% CI: 1.12-1.98) on CIR. Test of interaction showed a homogeneity of results among subgroups.

Accuracy of 18F-FDG in Detecting Stage I Lung Adenocarcinomas According to IASLC/ATS/ERS Classification

“…Nevertheless, some studies have reported a remarkable FN rate in invasive lung adenocarcinoma, compared to other histological types such as squamous cell carcinoma, adenosquamous carcinoma, and large-cell carcinoma [8]. For this reason, we focused on invasive lung adenocarcinoma only, and our results indicate a not inconsiderable risk of FN findings in this context [12,25].…”

“…In recent years, there has been a growing awareness of the clinical implications of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histopathological classification of lung adenocarcinomas [9]. Several studies have evaluated the association between IASLC/ATS/ERS patterns and clinical characteristics, tumour features, cells of origin, mutational profile, and prognosis [10][11][12][13][14]. Nevertheless, only a few studies have tried to find a correlation between IASLC/ATS/ERS histopathological pattern and FDG-PET findings [15].…”

Lobe-Specific Node Dissection Can Be a Suitable Alternative to Systematic Lymph Node Dissection in Highly Selective Early-Stage Non-Small-Cell Lung Cancer Patients: A Meta-Analysis

“…Last year, an article reported the cumulative incidence of recurrence (CIR) between LND and SND. 28) And the result showed a significantly higher CIR in LND group. Another study reported that even in clinical stage Ia patients, mediastinal lymph node metastases or beyond lobe-specific zone were sometimes found.…”

Role of adjuvant therapy in T1-2N0 resected non–small cell lung cancer

“…Among stage I adenocarcinomas, multiinstitution studies have observed a 26% recurrence rate after complete surgical resection. 5 Therefore, it is clear that some patients retain micrometastatic disease after complete resection of early-stage lung cancer. Systemic therapy improves survival in patients with micrometastatic disease.…”