Pathological Stage IA Non-small Cell Research Articles

Preoperative respiratory assessment predicts post-operative survival in stage IA non-small cell lung cancer.

Respiratory impairment can lead to pulmonary complications after surgery; therefore, it should be considered when determining the choice of surgical procedure. Several studies have examined the relationship between preoperative respiratory function and postoperative mortality and morbidity after lung resection; however, there are no indicators for limited surgical procedure selection. The aim of this study was to examine the association between preoperative respiratory function and postoperative early and late complications, recurrence-free survival (RFS), and overall survival (OS) in patients undergoing pulmonary resection for stage I lung cancer. We performed a retrospective analysis of data from 192 patients undergoing pulmonary resection for primary pathological stage IA non-small cell lung cancer (NSCLC) at the Iwakuni Clinical Center in Japan between 2012 and 2015. We reviewed clinicopathological characteristics including preoperative pulmonary function and elucidated the relationship between them and postoperative survival. Obstructive ventilatory impairment was present in 55 patients (28.6%), and restrictive ventilatory impairment was present in 31 patients (16.1%). Seven patients (3.6%) had both ventilatory impairment. Obstructive ventilatory impairment did not affect the 5-year RFS (P=0.08) or OS (P=0.21). However, restrictive ventilatory impairment reduced the 5-year RFS (P=0.002) and OS (P=0.009). The rates of early and late complications were not significantly different based on the preoperative respiratory function. In patients with preoperative restrictive ventilatory impairment in whom lobectomy or segmentectomy cannot be performed, careful consideration is needed for surgical indications.

Is wedge resection equivalent to segmentectomy in pathological stage IA (≤2 cm) non-small cell lung cancers?

Sublobar resection (wedge resection and segmentectomy) has been established as an oncologically equivalent option to lobectomy for early-stage patients with non-small cell lung cancer (NSCLC) ≤ 2 cm. However, the optimal approach of sublobar resection remains subject to debate. In the present study we aimed to compare the oncological outcomes of wedge resection and segmentectomy in these patients. We identified patients with pT1a-bN0M0 NSCLC who underwent wedge resection and segmentectomy from the Surveillance, Epidemiology, and End Results database between 2010 and 2020. A Cox regression model and propensity-score matching (PSM) analysis were used. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared using the Kaplan-Meier method. A total of 4190 patients met our selection criteria, including wedge resection in 3137 and segmentectomy in 1053. Patients undergoing wedge resection were less likely to have total lymph nodes resected (4 vs. 7, p < 0.001). Before PSM, patients undergoing segmentectomy had a higher 5-year OS rate (87.75% vs. 82.72%; p = 0.0023), while exhibiting a similar LCSS rate (93.45% vs. 92.73%; p = 0.32). After PSM, segmentectomy consistently demonstrated significantly better OS and there was no statistically significant difference in LCSS. Analysis of causes of death revealed that a higher incidence of deaths related to other causes among patients undergoing wedge resection compared to those undergoing segmentectomy. Both wedge resection and segmentectomy yield comparable oncological outcomes for patients with NSCLC ≤ 2 cm, although segmentectomy exhibits superior OS due to less death related to other causes.

Long-term Survival After Lung Cancer Resection in the National Lung Screening Trial

BackgroundThis study sought to evaluate the long-term survival and causes of death after surgery among patients with pathologic stage IA non-small cell lung cancer (NSCLC) in the National Lung Screening Trial (NLST). MethodsPatients who underwent surgery and who had a diagnosis of pathologic stage IA NSCLC in the NLST were identified for analysis. The 5- and 10-year overall survival and lung cancer–specific survival, stratified by operation type, were evaluated. Among patients who underwent lobectomy, the causes of death and the cumulative incidence of lung cancer death were assessed. ResultsA total of 380 patients (n = 329, 86.6% lobectomy; n = 20, 5.3% segmentectomy; n = 31, 8.1% wedge resection) met inclusion criteria. Median follow-up time from the date of surgery was 7.8 years (interquartile range, 4.8-10.7 years). The 10-year overall survival rate was 58.3% (95% CI, 52.4%-63.8%) for lobectomy, 59.9% (95% CI, 33.2%-78.8%) for segmentectomy, and 45.2% (95% CI, 20.8%-66.9%) for wedge resection. The 10-year lung cancer–specific survival rate was 74.3% (95% CI, 68.6%-79.1%) for lobectomy, 81.3% (95% CI, 51.3%-93.8%) for segmentectomy, and 84.8% (95% CI, 64.0%-94.1%) for wedge resection. Lung cancer was the leading cause of death, accounting for 55.8% of deaths after lobectomy. The 10-year cumulative incidence of lung cancer death after lobectomy was 22.5% (95% CI, 18.3%-27.1%). ConclusionsThe 10-year overall survival rate after lobectomy among patients with pathologic stage IA NSCLC in the NLST was 58%. Lung cancer was the leading cause of death, accounting for more than 55% of deaths.

Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer.

Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3-5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer.

Minimally Invasive Anatomical Segmentectomy versus Lobectomy in Stage IA Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis was performed to assess potential differences in perioperative outcomes and disease-free survival (DFS) and overall survival (OS) of patients with pathological stage IA non-small cell lung cancer (NSCLC) who underwent minimally invasive anatomical segmentectomy or lobectomy. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of EMBASE (through Ovid), MEDLINE (via PubMed), and Cochrane CENTRAL was conducted. Two researchers independently reviewed each eligible study that included patients with stage IA NSCLC who underwent minimally invasive anatomical segmentectomy and lobectomy and compared perioperative and/or survival outcomes of patients. A total of 887 publications were identified. Of these, 10 articles met our eligibility criteria. A significantly higher number of lymph nodes were harvested in lobectomies. The two groups did not significantly differ in postoperative complication rates, DFS, and OS. Patients who underwent segmentectomy had shorter postoperative hospital stays. Minimally invasive lobectomy and segmentectomy showed comparable short-term and long-term outcomes in stage IA NSCLC patients. Postoperative complication rates were similar. Minimally invasive lobectomies are associated with a higher number of harvested lymph nodes, although this did not affect the final staging or the survival outcomes.

Segmentectomy Provides Comparable Outcomes to Lobectomy for Stage IA Non-small Cell Lung Cancer with Spread through Air Spaces

This study aimed to compare the recurrence-free survival (RFS) and overall survival (OS) among wedge resection (non-anatomical resection), segmentectomy and lobectomy for pathological stage IA non-small cell lung cancer (NSCLC) with spread through air spaces (STAS). Patients underwent surgical treatment for pathological stage IA NSCLC between January 1, 2005, and March 31, 2016, at our hospital. Surgical procedures were classified as lobectomy, segmentectomy, and wedge resection. Among the 555 analyzed cases, STAS was observed in 148 patients (26.7%). STAS was correlated with worse RFS (P < 0.001) and OS (P < 0.001) and was an independent poor prognostic factor for RFS (hazard ratio: 2.37, P < 0.001) and OS (hazard ratio: 2.02, P < 0.001) in the multivariate analysis. In patients with STAS, the RFS and OS in the segmentectomy group were comparable to those in the lobectomy group. However, the RFS and OS in the wedge resection group were significantly lower than those in the lobectomy group (RFS, P < 0.001; OS, P=0.001). Wedge resection was an independent prognostic factor for poor RFS (hazard ratio [HR]=3.87; 95% confidence interval [CI]=1.84 - 8.12, P < 0.001), and poor OS (hazard ratio [HR]=3.39; 95% confidence interval [CI]=1.33 - 8.76, P=0.011) in the multivariate analysis. Segmentectomy is an adequate operation for patients with stage IA NSCLC with or without STAS. However, wedge resection is associated with a higher risk of recurrence in this patient population.

Nomogram to Predict Cancer Specific Survival in Patients with Pathological Stage IA Non-small Cell Lung Cancer

We identified the prognostic factors of resected stage IA non-small cell lung cancer (NSCLC) and developed a nomogram, with purpose of defining the high-risk population who may need closer follow-up or more intensive care. Eligible stage IA NSCLC cases from the Surveillance, Epidemiology, and End Results (SEER) database and the Sun Yat-sen University Cancer Center (SYSUCC) were included. Stage IB NSCLCs were also included for evaluating the risk stratification efficacy. Cancer specific survival (CSS) was compared between groups. Statistically significant factors from multivariate analysis were entered into the nomogram. The performance of the nomogram was evaluated by concordance index (C-index) and calibration plots. A total of 23,112 NSCLC cases (SEER stage IA training cohort, N=7,777; SEER stage IA validation cohort, N=7,776; SEER stage IB cohort, N=7,559) from the SEER database were included. 1,304 NSCLC cases (SYSUCC stage IA validation cohort, N=684; SYSUCC stage IB cohort, N=620) from the SYSUCC were also included. Younger age, female, lobectomy, well differentiated, smaller size and more examined lymph nodes were identified as favorable prognostic factors. A nomogram was established. The C-index was 0.68 (95%CI, 0.67-0.69), 0.66 (95% CI, 0.64-0.68) and 0.66 (95% CI, 0.61-0.71) for the SEER training cohort, SEER validation cohort and SYSUCC validation cohort. A risk classification system was constructed to stratify stage IA NSCLC into low-risk subgroup and high-risk subgroup. The CSS curves of these two subgroups showed statistically significant distinctions. This nomogram delivered a prognostic prediction for stage IA NSCLC and may aid individual clinical practice.

Clinical significance of intrapulmonary lymph node dissection in pathological stage IA non-small cell lung cancer: A propensity score matching analysis.

BackgroundThis study aimed to investigate the prognostic impact of intrapulmonary lymph node (ILN, stations 13–14) dissection on disease‐free survival (DFS) in stage IA non‐small cell lung cancer (NSCLC) patients in order to facilitate a more suitable determination of surgical strategies for early‐stage cases.MethodsWe retrospectively analyzed 416 patients with pathological stage IA NSCLC from February 2016 to November 2019. The patients were divided into a group with ILN dissection (ILND+ group) and a group without ILN dissection (ILND‐ group). DFS was compared using the Kaplan–Meier method and compared statistically using the log‐rank test before and after propensity score matching (PSM). Subgroup analysis of DFS stratified based on tumor size was also calculated.ResultsBoth before and after PSM, the four‐year DFS of the ILND+ group was greatly increased compared to that of ILND‐ group (90.1% vs. 79.7%, p = 0.003; 95.5% vs. 80.6%, p = 0.003, respectively) and multivariable cox regression analysis revealed ILN dissection was an independent factor favoring DFS in stage IA NSCLC (p = 0.016 and p = 0.015, respectively). Subgroup analysis revealed the four‐year DFS was comparable between the ILN D+ and ILND‐ groups with regard to tumor size ≤1.5 cm (90.6% vs. 92.7%, p = 0.715). However, the ILN D+ group was found to have a better oncological outcome compared with the ILND‐ group with regard to tumor size >1.5 cm (90.0% vs. 73.8%, p = 0.003).ConclusionsThe prognostic impact of ILN dissection on patients with stage IA NSCLC appears to be significantly influenced by tumor size, and this should be taken into account when choosing the most appropriate therapeutic modality.

P3.16-25 Impact of Diabetes Mellitus on Survival Outcome in Patients with Pathological Stage IA Non-Small Cell Lung Cancer

P3.16-25 Impact of Diabetes Mellitus on Survival Outcome in Patients with Pathological Stage IA Non-Small Cell Lung Cancer

Nomograms for predicting recurrence and survival of invasive pathological stage IA non-small cell lung cancer treated by video assisted thoracoscopic surgery lobectomy.

A considerable portion of pathological stage (p-stage) IA non-small cell lung cancer (NSCLC) patients suffered from death and recurrence after video assisted thoracoscopic surgery (VATS) lobectomy. The purpose of our study was to develop nomograms to predict which subgroup patients were more likely to suffer from recurrence or death. Data of invasive p-stage IA NSCLC patients who underwent VATS lobectomy at Peking University People's Hospital from September 2006 to April 2014 were analyzed. Multivariate Cox proportional hazards regression was used to develop nomograms. The performance of the nomograms was evaluated by Harrell's concordance index (C-index), calibration plots and risk group stratification. A total of 422 patients with NSCLC of invasive p-stage IA were included in the study. The median follow-up time was 40 months. Age [hazards ratio (HR) =1.067, 95% confidential interval (CI): 1.006-1.131], lymphovascular invasion (LVI) (HR=4.062, 95% CI: 1.278-12.912) and differentiation (HR =5.747, 95% CI: 2.151-15.353) were independent prognostic factors to predict overall survival (OS). Tumor diameter (HR =3.299, 95% CI: 1.814-6.001), LVI (HR =3.260, 95% CI: 1.221-8.708) and differentiation (HR =3.607, 95% CI: 1.776-7.327) were independent predictors of recurrence free survival (RFS). The nomogram for predicting OS demonstrated stronger discriminatory power than the 7th and 8th T stage systems (C-index: 0.894 for the nomogram, 0.700 for the 7th T stage and 0.742 for the 8th T stage). Likewise, the C-index of the nomogram for predicting RFS was higher than that of the 7th and 8th T stage systems (0.838 for the nomogram, 0.670 for the 7th T stage and 0.723 for the 8th T stage). We developed nomograms that could predict individual accurate prognosis for invasive p-stage IA NSCLC patients after VATS lobectomy. Risk stratification by the nomograms might guide further adjuvant chemotherapy and follow-up.

Prognostic impact of vascular invasion and standardization of its evaluation in stage I non-small cell lung cancer.

BackgroundPatients with pathologic stage (p-Stage) IA non-small cell lung cancer (NSCLC) have a good survival rate because of possible curative resection. However, up to 10% of these patients relapse postoperatively. To identify unfavorable prognostic factors, we retrospectively analyzed the clinicopathological features of p-Stage IA disease, focusing on vascular invasion.MethodsOf 467 patients with p-Stage I NSCLC, 335 were diagnosed with p-Stage IA or IB disease based on a lesion size ≤3 cm and the presence of pleural invasion (PL). Univariate and multivariate analyses of recurrence-free survival (RFS) were performed with age, sex, PL, and vascular invasion (blood vessel invasion [v] and lymphatic vessel invasion [ly]) as variables. To examine vascular invasion, hematoxylin-eosin (HE), Elastica van Gieson staining, and immunostaining with anti-podoplanin antibody were performed. The presence or absence of v and ly was recorded; the number of involved vessels was counted. Survival rates were obtained using the Kaplan–Meier method and log-rank test. Multivariate analyses were performed using the Cox proportional hazards model.ResultsRFS differed significantly between patients with no or one involved blood vessel (0 v or 1 v) and those with ≥2 involved vessels (≥2 v). Similarly, RFS differed significantly between patients with no lymphatic vessel involvement (0 ly) and those with one involved lymphatic vessel (1 ly). Thus, BVI(+) and BVI(−) were defined as ≥2 v and 0 v + 1 v, and LVI(+) and LVI(−) as ≥1 ly and 0 ly, respectively. BVI and LVI together represented tumor vessel invasion (TVI). On multivariate analyses, PL and TVI were independently associated with recurrence. Additionally, patients with p-Stage IA TVI(+) disease had a comparable recurrence rate to those with p-Stage IB disease.ConclusionsSimilar to PL, TVI is an important factor increasing the likelihood of recurrence. As HE staining alone is insufficient for evaluating vascular invasion, specific staining is necessary. Moreover, patients with p-Stage IA TVI(+) disease had a recurrence rate comparable to those with p-Stage IB disease; therefore, further studies should aim to elucidate whether patients with p-Stage IA TVI(+) disease should be administered postoperative chemotherapy similar to that received by p-Stage IB patients.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5213064891369688

Predictive value of 18F-FDG PET and CT morphologic features for recurrence in pathological stage IA non-small cell lung cancer.

Patients with pathological stage IA non-small cell lung cancer (NSCLC) may relapse despite complete surgical resection without lymphovascular invasion. A method of selecting a high-risk group for adjuvant therapy is necessary. The aim of this study was to assess the predictive value of 18F-fluorodeoxyglucose (FDG) uptake and the morphologic features of computed tomography (CT) for recurrence in pathological stage IA NSCLC.One hundred forty-five patients with pathological stage IA NSCLC who underwent pretreatment with FDG positron emission tomography and CT evaluations were retrospectively enrolled. The associations among tumor recurrence and patient characteristics, maximal standard uptake value (SUVmax) of primary tumors, and CT imaging features were investigated using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of these factors.Tumor recurrence developed in 21 (14.5%) of the 145 patients, and the 5-year recurrence-free survival rate was 77%. The univariate analysis demonstrated that SUVmax, the grade of histological differentiation, tumor size, and the presence of bronchovascular bundle thickening were significant predictive factors (P < 0.05). A higher SUVmax (≥2.5) (P = 0.021), a lower ground-glass opacity ratio (≤17%) (P = 0.014), and the presence of bronchovascular bundle thickening (P = 0.003) were independent predictive factors of tumor recurrence in the multivariate analysis. The use of this predictive model yielded a greater area under the ROC curve (0.877), which suggests good discrimination.The combined evaluation of FDG uptake and CT morphologic features may be helpful in the prediction of recurrence in patients with pathological stage IA NSCLC and in the stratification of a high-risk group for postoperative adjuvant therapy or prospective clinical trials.

Survival After Surgery for Pathologic Stage IA Non-Small Cell Lung Cancer Associated With Idiopathic Pulmonary Fibrosis

Many problems exist in regard to the treatment of lung cancer patients with idiopathic pulmonary fibrosis (IPF), but few reported studies have investigated the long-term prognosis after pulmonary resection in such patients. The purpose of the present study was to determine the postoperative survival of patients with pathologic stage IA non-small cell lung cancer (NSCLC) and IPF. We retrospectively reviewed 350 patients with pathologic stage IA NSCLC who underwent pulmonary resections at our institution between September 1994 and December 2007. We analyzed and compared 28 of these patients, who had simultaneous lung cancer and IPF, with the remaining 322 lung cancer patients without IPF. The 5-year survival rates were 54.2% in pathologic stage IA lung cancer patients with IPF and 88.3% in those without IPF (p < 0.0001). Univariate analyses showed that age, sex, Brinkman Index, limited resection, operation time, adenocarcinoma, and IPF were significant prognostic factors for survival (p < 0.10). By multivariate analysis, however, only IPF was a significant prognostic factor for survival (p = 0.007). Propensity score-matching analysis confirmed that only IPF was significant prognostic factor (p = 0.043). The 5-year survival rate of patients with pathologic stage IA NSCLC and IPF is 54.2%. IPF has independent, adverse effects on survival of pathologic stage IA NSCLC patients treated with pulmonary resection.

Prognostic impact of MMP‐2 and MMP‐9 expression in pathologic stage IA non‐small cell lung cancer

The purpose of the present study was to assess the value of matrix metalloproteinase (MMP)-2 and MMP-9 expression and other potential prognostic factors in predicting the clinical outcome of patients after definitive surgery for pathologic stage IA non-small cell lung cancer (NSCLC). One hundred and forty-six consecutive and non-selected patients who underwent definitive surgery for stage IA NSCLC were included in this study. Formalin-fixed paraffin-embedded specimens were stained for MMP-2 and MMP-9, which were statistically evaluated for their prognostic value and other clinicopathological parameters. Of the 146 patients studied, 102 (69.9%) cases were classified as having high expression for MMP-2. A total of 89 carcinomas (61.0%) had high expression for MMP-9. MMP-9 expression correlated with Eastern Cooperative Oncology Group (ECOG) performance status, pT stage, and differentiation (P = 0.005, <0.001, and <0.001, respectively). Vessel invasion, pT stage, and MMP-9 expression maintained their independent prognostic influence on overall survival (P = 0.037, <0.001, and <0.001, respectively). From results of our relatively large database, MMP-9 may be considered as a viable biomarker that can be used in conjunction with other prognostic factors such as vessel invasion and pT stage to predict the prognosis of patients with completely resected pathologic stage IA NSCLC.

Prognostic Significance of Intratumoral Blood Vessel Invasion in Pathologic Stage IA Non-Small Cell Lung Cancer

The 5-year survival rate of pathologic stage IA non-small cell lung cancer (NSCLC) is excellent; however, up to 10% of patients with pathologic stage IA NSCLC still relapse postoperatively and die. This study retrospectively analyzed the clinicopathologic features of patients with pathologic stage IA NSCLC to identify the prognostic factors and investigate the effect of a combination of intratumoral vessel invasion and tumor size. From December 1991 to December 2003, 217 consecutive patients with stage IA NSCLC were selected, and disease-free survival (DFS) was analyzed. Intratumoral blood vessel invasion (BVI) was identified as an independent poor prognostic factor (p = 0.0006). The relative risk for patients with BVI was 4.599 times higher than that for patients without BVI (95% confidence interval, 1.913 to 11.056). According to the new T N M system, the difference in DFS between the patients with and without BVI was statistically significant, not only in tumors exceeding 2 cm (T1b with BVI vs T1b without BVI, p = 0.0020) but also in tumors smaller than 2 cm (T1a with BVI vs T1a without BVI, p < 0.0001). The survival curve of T1b patients without BVI was similar to that of T1a patients without BVI (p = 0.0892). Distant recurrence was frequently observed in both T1a and T1b patients with BVI. BVI is an independent poor prognostic factor in patients with pathologic stage IA NSCLC. These T1a and T1b patients with BVI both might benefit from adjuvant chemotherapy.

Accuracy and prognostic impact of a vessel invasion grading system for stage IA non-small cell lung cancer

Background Despite the recognition that lymphatic and blood vessel invasion is an important prognostic factor in lung cancer, there is no common definition for pathological evaluation of vessel invasion. The aim of the present study was to determine whether D2-40 immunostaining can increase the accuracy of detection of lymphatic vessel invasion and whether our new grading system of vessel invasion by “degree” could be used instead of conventional evaluation by “presence” for pathological stage IA non-small cell lung cancer (NSCLC). Methods The vessel invasion classification was re-evaluated in 221 recent paraffin-embedded sections of p-stage IA NSCLC stained by Hematoxylin-Eosin (HE), Elastica-Van-Gieson (EVG), and D2-40. Results After re-assessment using D2-40 immunostaining, 41.2% (31 of 75) of ly1 cases by HE/EVG changed to ly0, and 14.9% (17 of 114) of ly0 cases by HE/EVG changed to ly1. Overall, 4 of 28 ly2 cases on conventional staining were changed to ly1, and 2 were changed to ly0 using D2-40 immunostaining. When the patients were divided into two groups by the presence of vessel invasion (v/ly0 vs. 1, 2, 3), there was no significant difference in cancer-specific survival ( p = 0.1107, 0.0875, respectively), while when they were divided according to degree of vessel invasion (v/ly0, 1 vs. 2, 3), there was a statistically significant difference ( p = 0.0038, p = 0.0002, respectively). On multivariate analysis, lymphatic vessel invasion had a significant impact on cancer-specific survival ( p = 0.0061). Conclusion Our results suggest that D2-40 immunostaining provides a precise diagnosis of lymphatic vessel invasion, and our new grading system of vessel invasion by “degree” is accurate and has prognostic value in early lung cancer.

P1-008: Immunohistochemical expression of Cap43 protein in pathological stage IA nonsmall cell lungcancer

P1-008: Immunohistochemical expression of Cap43 protein in pathological stage IA nonsmall cell lungcancer

Invited commentary

The authors [1Hsu W.-H. Huang C.-S. Hsu H.-S. et al.Preoperative serum carcinoembryonic antigen level is a prognostic factor in women with early non-small-cell lung cancer.Ann Thorac Surg. 2007; 83: 419-424Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar] examined the role of serum carcinoembryonic antigen (CEA) level as a prognostic factor in patients with nonsmall cell lung cancer (NSCLC). Small studies have examined this serum marker; however CEA has not yet reached the level of evidence necessary for incorporation into consensus conference guidelines for staging or prognosis. Still, studies from Japan [2Inoue M. Minami M. Shiono H. Sawabata N. Ideguchi K. Okumura M. Clinicopathologic study of resected, peripheral, small-sized, non-small cell lung cancer tumors of 2 cm or less in diameter: pleural invasion and increase of serum carcinoembryonic antigen level as predictors of nodal involvement.J Thorac Cardiovasc Surg. 2006; 131: 988-993Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar, 3Sawabata N. Maeda H. Yokota S. et al.Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma: subnormal levels as an indicator of favorable prognosis.Cancer. 2004; 101: 803-809Crossref PubMed Scopus (42) Google Scholar] and the current study from Taiwan, have suggested that increased levels of CEA may be associated with poorer prognosis. In this article, the authors describe a population of nonsmoking Taiwanese women (92.4% without a history of cigarette smoking) with predominantly adenocarcinoma and bronchoalveolar carcinoma (83.4%). Lobectomy was performed in 87% of these individuals. Elevated preoperative CEA levels (>6.0 ng/mL) and larger tumor size were associated with poorer prognosis. Are these findings related to histology, ethnicity, or other genetic alterations that may predispose to adenocarcinoma in nonsmoking women? The answer to these and other questions will require a larger analysis of prospectively collected serum, tissue, and clinical data. However, until completion of these analyses, patients with an adenocarcinoma of the lung, particularly in women nonsmokers, may be considered for serum CEA level determination. Patients with CEA ≥6 ng/mL may represent a population with poorer survival mandating closer follow-up and consideration for multimodality or other targeted therapies [4Okamoto T. Nakamura T. Ikeda J. et al.Serum carcinoembryonic antigen as a predictive marker for sensitivity to gefitinib in advanced non-small cell lung cancer.Eur J Cancer. 2005; 41: 1286-1290Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar]. Although adjuvant chemotherapy is not a current recommendation for stage I NSCLC, the ability to predict those stage I patients with poor prognosis would be helpful. Early-stage, poor-prognosis patients could be selected for specific therapies for subsequent survival benefit compared with current models of observation alone. The poorer survival with increased preoperative CEA in nonsmoking Asian women must be considered in relationship to women (and men) of various ethnicities and smoking status. These small retrospective independent studies, may provide models for subsequent evaluation of CEA and other serum markers for staging, prognosis, and therapy for patients with early stage NSCLC. Preoperative Serum Carcinoembryonic Antigen Level is a Prognostic Factor in Women With Early Non–Small-Cell Lung CancerThe Annals of Thoracic SurgeryVol. 83Issue 2PreviewCarcinoembryonic antigen (CEA) is one of the markers evaluated in patients with non–small cell lung cancer (NSCLC). The significance of the preoperative serum CEA level in female patients with NSCLC is seldom discussed. In this study, we conducted a retrospective review to investigate the prognostic significance of the preoperative CEA level in female patients with stage I NSCLC. Full-Text PDF

Prognostic impact of large cell neuroendocrine histology in patients with pathologic stage Ia pulmonary non–small cell carcinoma

Most patients with pathologic stage Ia non-small cell lung carcinoma have a good prognosis, and adjuvant chemotherapy is currently not being used in the management of this stage of the disease. However, if significant negative prognostic factors become evident in patients with pathologic stage Ia non-small cell lung carcinoma, patients with negative prognostic factors should have adjuvant treatment after surgery. We analyzed 335 cases of pathologic stage Ia non-small cell lung carcinoma treated between 1988 and 2003 by complete resection. The pathologic stage Ia non-small cell lung carcinomas comprised 259 adenocarcinomas, 65 squamous cell carcinomas, and 11 large cell neuroendocrine carcinomas. The prognostic impact of various clinical variables was investigated by the Cox proportional hazards multivariable regression model. Univariate analysis showed that large cell neuroendocrine carcinoma histology, old age, large tumor size, male gender, and smoking predicted poorer overall survival. Large cell neuroendocrine carcinoma had a significantly poorer prognosis than other non-small cell carcinomas. Multivariate analysis revealed that large cell neuroendocrine carcinoma was predictive of poorer overall survival (P = .0200, hazard ratio 2.787). Large cell neuroendocrine histology has a significant adverse prognostic impact on pathologic stage Ia non-small cell carcinoma. Therefore, surgical resection alone represents insufficient treatment for large cell neuroendocrine carcinoma, even for pathologic stage Ia disease.

Survival After Pathological Stage IA Nonsmall Cell Lung Cancer: Tumor Size Matters

This study evaluates prognostic factors for survival in completely resected pathological stage IA nonsmall cell lung cancer with special emphasis on tumor size and assesses tumor recurrence rate by actual and actuarial analysis. From January 1989 to December 2001, 130 consecutive resections for pathological stage IA nonsmall cell lung cancer were performed. Pathological tumor size was categorized into 0 to 20 mm and 21 to 30 mm. Each patient was scaled according to the Charlson Comorbidity Index. The Kaplan-Meier method was used for estimation of actuarial recurrence rate and the cumulative incidence method was used to estimate the actual recurrence rate. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis. Overall 5-year survival for patients with tumors 0 to 20 mm and 21 to 30 mm was 69% and 51%, respectively (p = 0.038). Disease-free survival at 5 years was 68% and 48%, respectively (p = 0.015). Only 27 patients had a recurrence and 69 patients died during follow-up. The actual 10-year recurrence rate was lower than the actuarial recurrence rate (23% vs 29%). Larger tumor size (relative risk 1.6; 95% confidence interval 1.0 to 2.7), Charlson Comorbidity Index score greater than or equal to 3 (relative risk 3.7; 95% confidence interval 1.7 to 8.0), and pneumonectomy (relative risk 2.1; 95% confidence interval 1.1 to 4.2) independently predicted adverse outcome. Tumor size affects survival in resected stage IA nonsmall cell lung cancer. Current definition of stage IA disease should be substaged into two separate stages. In patients with early-stage lung cancer and relatively good prognosis actual recurrence rate is more realistic than the actuarial recurrence rate.