Implications of the eighth edition of the TNM proposal: Invasive versus total tumor size for the T descriptor in pathologic stage I-IIA lung adenocarcinoma Journal Article

   

Authors:	Kameda, K.; Eguchi, T.; Lu, S.; Qu, Y.; Tan, K. S.; Kadota, K.; Adusumilli, P. S.; Travis, W. D.
Article Title:	Implications of the eighth edition of the TNM proposal: Invasive versus total tumor size for the T descriptor in pathologic stage I-IIA lung adenocarcinoma
Abstract:	Introduction: The eighth edition of the TNM staging system included the proposal that the T descriptor be determined according to the invasive component, excluding lepidic component, for nonmucinous lung adenocarcinomas. We sought to conduct a clinicopathologic comparative analysis of the newly proposed classification using invasive size versus total tumor size. Methods: Patients who underwent lung resection for primary lung adenocarcinoma with pathologic stage (p-Stage) I-IIA (based on total size [t]) were reviewed (n = 1704). Pathologic invasive size was measured, and tumors were reclassified using invasive size (i). Cumulative incidence of recurrence and lung cancer–specific cumulative incidence of death were analyzed using a competing-risks approach. Prognostic discrimination by p-Stage(t) and p-Stage(i) was evaluated using a concordance index (C-index). Results: The use of invasive size resulted in downstaging in 377 of 1704 patients (22%), with twice as many patients with p-Stage IA1 (IA1[i] versus IA1[t]: 389 [23%] versus 195 [11%]). However, outcomes were similar between the two groups (IA1[i] versus IA1[t]: 5-year cumulative incidence of recurrence, 11% versus 13%; 5-year lung cancer–specific cumulative incidence of death, 5% versus 7%). Prognostic discrimination by p-Stage(i) was better than by p-Stage(t) (C-index for p-Stage[i] versus p-Stage[t]: recurrence, 0.614 versus 0.593; lung cancer–specific death, 0.634 versus 0.621). Conclusions: When invasive size, rather than total size, was used for the T descriptor, a larger number of patients were classified with a favorable prognosis (p-Stage IA1) and better prognostic discrimination of p-Stage I-IIA nonmucinous lung adenocarcinomas was achieved. © 2018 International Association for the Study of Lung Cancer
Keywords:	recurrence; lung adenocarcinoma; invasive tumor size; consolidation tumor size; lung cancer–specific death
Journal Title:	Journal of Thoracic Oncology
Volume:	13
Issue:	12
ISSN:	1556-0864
Publisher:	Elsevier Inc.
Date Published:	2018-12-01
Start Page:	1919
End Page:	1929
Language:	English
DOI:	10.1016/j.jtho.2018.08.2022
PUBMED:	30195703
PROVIDER:	scopus
PMCID:	PMC6309787
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054155385&doi=10.1016%2fj.jtho.2018.08.2022&partnerID=40&md5=e9f9b16fc187f61e4686ef32e7f0365b
Notes:	Article -- Export Date: 3 December 2018 -- Source: Scopus