Abstract
BackgroundWe hypothesize that recurrence hazard following resection for stage I-IIA lung adenocarcinoma (ADC) varies according to histologic subtype, which may provide risk stratification for surveillance better than the current uniform follow-up protocol.ResultsPresence (≥5%) of high-grade histologic subtypes (MIP and/or SOL) was associated with a significantly higher recurrence hazard: (1) presence of either MIP or SOL was associated with a significant increase in recurrence hazard during the first two years after surgery; (2) presence of SOL was associated with an increase in recurrence hazard—in particular, distant recurrence hazard—during the first year after surgery; (3) absence of high-grade subtypes (515/1,572 patients) was associated with a very low recurrence hazard (<2% risk/year) during the first ten years after surgery.MethodsAll hematoxylin and eosin–stained tumor slides from pathologic stage I-IIA lung ADC (n = 1572) were reviewed for quantification of the percentage of each histological subtype. Recurrence hazard was estimated using the Kernel-Epanechnikov smoothing procedure. The association between recurrence hazard and high-grade histologic subtypes (micropapillary [MIP] and solid [SOL]) was assessed.ConclusionsOur findings suggest that histologic subtyping has utility for identifying recurrence hazard for surgically resected stage I-IIA lung ADC patients and provide rationale for establishing risk-based surveillance.
Highlights
Our findings suggest that histologic subtyping has utility for identifying recurrence hazard for surgically resected stage I-IIA lung ADC patients and provide rationale for establishing risk-based surveillance
Complete resection offers the best possibility of cure for patients with early-stage non-small cell lung cancer (NSCLC) and appropriately selected patients with locally advanced NSCLC [1]
For resected pathologic stage I-IIA lung ADC, (1) recurrence hazard was clearly stratified by presence of high-grade histologic subtypes (MIP, SOL); (2) presence of high-grade histologic subtypes was associated with a significant increase in recurrence hazard during the first two years after surgery; (3) presence of SOL subtype was associated with a significant increase in hazard of recurrence—in particular, distant recurrence—during the first year after surgery; and (4) recurrence hazard in patients with no high-grade subtypes (MIP–/SOL–; one-third of patients) was consistently very low (
Summary
Complete resection offers the best possibility of cure for patients with early-stage non-small cell lung cancer (NSCLC) and appropriately selected patients with locally advanced NSCLC [1]. National practice guidelines for stage I NSCLC recommend intensive surveillance during the first two years after surgery [4,5,6,7], as the recurrence hazard during this period has been reported to be much higher than in later years [8, 9]. Outcomes following surgery may vary between cure or early or late recurrence, individualized risk stratification for rational surveillance is not currently available [10,11,12,13]. We hypothesize that recurrence hazard following resection for stage I-IIA lung adenocarcinoma (ADC) varies according to histologic subtype, which may provide risk stratification for surveillance better than the current uniform follow-up protocol
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