Procedure-specific risk prediction for recurrence in patients undergoing lobectomy or sublobar resection for small (≤2 cm) lung adenocarcinoma: An international cohort analysis Journal Article


Authors: Bains, S.; Eguchi, T.; Warth, A.; Yeh, Y. C.; Nitadori, J. I.; Woo, K. M.; Chou, T. Y.; Dienemann, H.; Muley, T.; Nakajima, J.; Shinozaki-Ushiku, A.; Wu, Y. C.; Lu, S.; Kadota, K.; Jones, D. R.; Travis, W. D.; Tan, K. S.; Adusumilli, P. S.
Article Title: Procedure-specific risk prediction for recurrence in patients undergoing lobectomy or sublobar resection for small (≤2 cm) lung adenocarcinoma: An international cohort analysis
Abstract: Introduction: This work was performed to develop and validate procedure-specific risk prediction for recurrence following resection for early-stage lung adenocarcinoma (ADC) and investigate risk prediction utility in identifying patients who may benefit from adjuvant chemotherapy (ACT). Methods: In patients who underwent resection for small (≤2 cm) lung ADC (lobectomy, 557; sublobar resection, 352), an association between clinicopathologic variables and risk of recurrence was assessed by a competing risks approach. Procedure-specific risk prediction was developed based on multivariable regression for recurrence. External validation was conducted using cohorts (N = 708) from Japan, Taiwan, and Germany. The accuracy of risk prediction was measured using a concordance index. We applied the lobectomy risk prediction approach to a propensity score–matched cohort of patients with stage II-III disease (n = 316, after matching) with or without ACT and compared lung cancer–specific survival between groups among low- or high-risk scores. Results: Micropapillary pattern, solid pattern, lymphovascular invasion, and necrosis were involved in the risk prediction following lobectomy, and micropapillary pattern, spread through air spaces, lymphovascular invasion, and necrosis following sublobar resection. Both internal and external validation showed good discrimination (concordance index in lobectomy and sublobar resection: internal, 0.77 and 0.75, respectively; and external, 0.73 and 0.79, respectively). In the stage II-III propensity score–matched cohort, among high-risk patients, ACT significantly reduced the risk of lung cancer–specific death (subhazard ratio 0.43, p = 0.001), but not among low-risk patients. Conclusions: Procedure-specific risk prediction for patients with resected small lung ADC can be used to better prognosticate and stratify patients for further interventions. © 2018 International Association for the Study of Lung Cancer
Keywords: adult; controlled study; human tissue; aged; human cell; major clinical study; overall survival; cancer recurrence; cancer adjuvant therapy; cancer staging; antineoplastic agent; cancer grading; tumor volume; lung lobectomy; lung resection; cohort analysis; recurrence; smoking; retrospective study; necrosis; prediction; risk factor; high risk patient; age; lung adenocarcinoma; cancer specific survival; adjuvant chemotherapy; japan; taiwan; germany; sex; pleural invasion; sublobar resection; micropapillary pattern; propensity score; low risk patient; solid pattern; lymph vessel metastasis; human; male; female; priority journal; article; competing risks analysis; lung cancer–specific death; spread through air space
Journal Title: Journal of Thoracic Oncology
Volume: 14
Issue: 1
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2019-01-01
Start Page: 72
End Page: 86
Language: English
DOI: 10.1016/j.jtho.2018.09.008
PROVIDER: scopus c2 - 30253972
PMCID: PMC6309652
PUBMED: 30253972
DOI/URL:
Notes: J. Thorac. Oncol. -- Export Date: 2 January 2019 -- Article -- Source: Scopus C2 - 30253972
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Citation Impact
MSK Authors
  1. William D Travis
    611 Travis
  2. Kyuichi Kadota
    84 Kadota
  3. Sarina Bains
    19 Bains
  4. David Randolph Jones
    210 Jones
  5. Kaitlin Marie Woo
    100 Woo
  6. Takashi   Eguchi
    71 Eguchi
  7. Kay See   Tan
    117 Tan
  8. Shaohua   Lu
    23 Lu