Does the histologic predominance of pathological stage IA lung adenocarcinoma influence the extent of resection?

• Published in: General thoracic and cardiovascular surgery Vol. 65; no. 9; pp. 512 - 518
• Main Authors: Ito, Hiroyuki, Nakayama, Haruhiko, Murakami, Shuji, Yokose, Tomoyuki, Katayama, Kayoko, Miyata, Yoshihiro, Okada, Morihito
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2017; Springer Nature B.V
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Cardiac Surgery; Cardiology; Classification; Female; Follow-Up Studies; Humans; Influence; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymphatic system; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Original Article; Pneumonectomy; Retrospective Studies; Risk Factors; Surgical Oncology; Thoracic Surgery; Tomography; Tumors; Variables; Adenocarcinoma; Pathological stage IA; Predominant subtype; Lung cancer; Surgery
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-017-0790-0

Objectives We studied whether histologic subtype according to the new IASLC/ATS/ERS adenocarcinoma classification influences the extent of resection in patients with pathological stage IA lung adenocarcinoma. Methods Data on 288 patients with pathological stage IA lung adenocarcinoma were analyzed retrospectively. Recurrence-free survival (RFS) rates were compared according to clinicopathological characteristics, including predominant histologic subtype and extent of resection. Results Median follow-up was 38.9 months. Lobectomy was performed in 146 patients, and sublobar resection in 142 patients. When recurrence was compared among the low-grade group (adenocarcinoma in situ, AIS; minimally invasive adenocarcinoma, MIA), intermediate-grade group (lepidic, acinar, and papillary) and high-grade group (solid and micropapillary), the RFS rate decreased as the grade increased ( p  = 0.037). There was no recurrence in the low-grade or lepidic predominant groups. The recurrence pattern did not differ according to the type of resection or histological subtype. Even in the intermediate- and high-grade groups, the extent of resection was not significantly related to the RFS rate ( p  = 0.622, p  = 0.516). The results were unchanged after adjusting for independent risk factors. The concordance rate between clinical and pathological stage IA was good in low (98.6%) and intermediate grade (84.6%) and poor in high grade (41.2%). Conclusions AIS, MIA, and lepidic predominant may be curable by any type of complete resection. Even in invasive subtypes, lobectomy does not offer a recurrence-free advantage over sublobar resection. However, in the high-grade group, less than half of clinical stage IA was actually pathological stage IA. Physicians should exercise caution whenever sublobar resection is planned.