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Ann Thorac Surg. 2019 Jul 20. pii: S0003-4975(19)31046-X. doi: 10.1016/j.athoracsur.2019.05.080. [Epub ahead of print]

High-Risk Factors for Recurrence of Stage I Lung Adenocarcinoma: Follow-up Data from JCOG0201.

Author information

1
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. Electronic address: tsutani@hiroshima-u.ac.jp.
2
Department of Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
3
Department of Surgery, Niigataseirou Hospital, Niigata, Japan.
4
Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
5
Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
6
Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
7
Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
8
Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
9
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
10
Department of Thoracic Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
11
Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
12
Dapartment of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan.
13
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.

Abstract

BACKGROUND:

The aim of this study was to identify patients with pathological stage I lung adenocarcinoma at high risk of recurrence.

METHODS:

We retrieved data from 536 patients with pathological stage I lung adenocarcinoma who underwent lobectomy and were enrolled in a prospective multi-institutional study (JCOG0201). Invasive component size, excluding lepidic component, was used as the tumor size. Recurrence-free survival (RFS) was estimated by the Kaplan-Meier method, and a multivariable Cox proportional hazards model identified independent prognostic factors associated with worse RFS.

RESULTS:

The all-patient 10-year RFS was 83.9% (median follow-up, 10.2 years). Multivariable Cox analysis revealed that age [>65 y: hazard ratio, 2.60; 95% confidence interval (CI), 1.66-4.07], invasive component size (>2 cm: hazard ratio, 2.70; 95% CI, 1.40-5.23), visceral pleural invasion (hazard ratio, 2.17; 95% CI, 1.23-3.81), and vascular invasion (hazard ratio, 2.59; 95% CI, 1.47-4.55) were potential independent prognostic factors for RFS. When patients were divided into a high-risk group for recurrence (invasive component size > 2 cm or positive for visceral pleural invasion or for vascular invasion; n = 124) and a low-risk group (invasive component size < 2 cm and negative for visceral pleural invasion and vascular invasion; n = 408), there was a significant difference in RFS between the high-risk and low-risk groups (high-risk: hazard ratio, 3.61; 95% CI, 2.35-5.55).

CONCLUSIONS:

Pathological stage I lung adenocarcinoma patients with an invasive component size > 2 cm, visceral pleural invasion, or vascular invasion were at high-risk for recurrence.

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