Histologic subtype in core lung biopsies of early-stage lung adenocarcinoma is a prognostic factor for treatment response and failure patterns after stereotactic body radiation therapy Journal Article


Authors: Leeman, J. E.; Rimner, A.; Montecalvo, J.; Hsu, M.; Zhang, Z.; von Reibnitz, D.; Panchoo, K.; Yorke, E.; Adusumilli, P. S.; Travis, W.; Wu, A. J.
Article Title: Histologic subtype in core lung biopsies of early-stage lung adenocarcinoma is a prognostic factor for treatment response and failure patterns after stereotactic body radiation therapy
Abstract: Purpose Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype. Methods and Materials We identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non–high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score–weighted Cox regression models. Results The median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non–high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival. Conclusions The outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype determined from core biopsies is a prognostic factor and could have important implications for patient selection, adjuvant treatment, biopsy methods, and clinical trial design. © 2016 Elsevier Inc.
Keywords: radiotherapy; biopsy; confidence interval; tumors; world health organization; patient treatment; regression analysis; stereotactic body radiation therapy; biological organs; cumulative incidence; risk perception; adjuvant treatment; methods and materials; early-stage lung cancers; clinical trial designs
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 97
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2017-01-01
Start Page: 138
End Page: 145
Language: English
DOI: 10.1016/j.ijrobp.2016.09.037
PROVIDER: scopus
PMCID: PMC5161605
PUBMED: 27839909
DOI/URL:
Notes: Article -- Export Date: 3 January 2017 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    244 Zhang
  2. Meier Hsu
    104 Hsu
  3. William D Travis
    552 Travis
  4. Andreas Rimner
    257 Rimner
  5. Abraham Jing-Ching Wu
    202 Wu
  6. Ellen D Yorke
    314 Yorke
  7. Jonathan Eric Leeman
    63 Leeman