PURPOSE: 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). BASIC PROCEDURES: In patients who underwent resection for small (=2 cm) lung ADC (lobectomy, 557; sublobar resection, 352), an association between clinicopathological 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 (C-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. MAIN FINDINGS: 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 (C-index in lobectomy and sublobar resection: internal, 0.77 and 0.75; and external, 0.73 and 0.79). 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. PRINCIPAL CONCLUSIONS: Procedure-specific risk prediction for patients with resected small lung ADC can be used to better prognosticate and stratify patients for further interventions.
- 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.
Keywords
- adjuvant chemotherapy
- competing risks analysis
- lung cancer-specific death
- recurrence
- sublobar resection