Search

Purpose: N2 lymph-node metastases occur in approximately 6–17% of the patients with T1-2 non-small cell lung cancer (NSCLC). However, the clinical characteristics of N2 patients are not fully understood. Methods: This retrospective, multi-center analysis included T1 NSCLC patients receiving surgical resection during a period from Jan 2nd, 2014 to Dec 27th, 2017. The diagnosis was pathologically verified in all cases. Univariate and multivariate logistic regression analyses were conducted to analyze the factors that are associated with pN2 lymph-node metastases. Results: A total of 10,885 patients (48.4% men; 84.7% adenocarcinoma) were included in the analysis. The mean age was 59.0 ± 9.9 years. The mean tumor size was 1.8 ± 0.8 cm. Of the patients, 3260 (29.9%) were smokers or ex-smokers. Lymph-node metastases were verified in 1808 (16.6%) patients, and 1167 (10.7%) patients had N2 lymph-node metastases. The multivariate analyses indicated that larger tumor size, lower differentiation, CEA level ≥ 5 ng/mL, vascular invasion (+), and pleural involvement (+) were associated with higher percentages of N2 lymph-node metastases (p < 0.001 for all). Conclusions: This study demonstrated the significant association between N2 lymph-node metastases and tumor size and differentiation, CEA levels, and status of vascular invasion and pleural involvement. [ABSTRACT FROM AUTHOR]

Purpose: Small cell lung cancer (SCLC) is considered a systemic disease and surgery is generally not recommended to treat it. High heterogeneity within the tumor and preoperative diagnostic capabilities can sometimes fail to identify SCLC correctly, leading to a subset of unexpected SCLC patients that are diagnosed only after pulmonary resections.Methods: We retrospectively reviewed the clinical records of patients who were diagnosed as having SCLC only after surgery between 2008 and 2015 at a single institution.Results: A total of 125 unexpected SCLC patients were identified, including those with pure (p-SCLC; n = 76, 60.8%) and combined (c-SCLC; n = 49, 39.2%) SCLC. Highly differential diagnoses were observed between pre- and postoperative tissue examinations. Sixty-nine (55.2%) patients with postoperatively pathological-proven SCLC, including 31 with p-SCLC and 38 with c-SCLC, were diagnosed preoperatively with poorly differentiated carcinoma (n = 23), squamous carcinoma (n = 14), adenocarcinoma (n = 10), malignant cells with necrosis (n = 10), large cell carcinoma (n = 8), or carcinoid (n = 4). Also, inconsistencies between the clinical (c-) and pathological (p-) stages were found in this cohort, which were less common in patients with preoperative PET examination than those without (24.4% vs. 43.8%; p = 0.032). Multivariable analyses showed that higher p-stage (hazards ratio (HR) = 1.7349, p = 0.0025), sub-lobar resection (HR = 1.9078, p = 0.0395), and a lack of prophylactic cranial irradiation treatment (PCI, HR = 0.3873, p = 0.0057) were unfavorable prognostic factors for overall survival.Conclusion: Non-resection approaches reveal an inadequate diagnosis of SCLC. PET examination facilitates the evaluation of the clinical staging of SCLC. For unexpected SCLC undergoing resection, favorable outcomes can be achieved if radical resection and postoperative PCI are performed. [ABSTRACT FROM AUTHOR]

Background: This retrospective research was designed to investigate the relationship between pT1N0M0 invasive adenocarcinoma (IADC) harboring solid (SOL) and/or micropapillary (MIP) components and its prognosis following lobectomy.Methods: Clinical data of pT1N0M0 IADC patients were retrospectively collected from Shanghai Chest Hospital. Survival curves were plotted by Kaplan-Meier methods. Multivariable cox regressions were conducted to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS), through which nomograms were performed to visualize the risk of recurrences and outcomes in personalized information.Results: Totally, 1965 patients were enrolled, including 248 harboring SOL/MIP and 1717 not. IADC demonstrated worse 5-year RFS (81.9 vs. 92.2%, p < 0.001) and OS (85.7 vs. 94.4%, p < 0.001) when harboring SOL and/or MIP components. And this status became an independent factor associated with poorer RFS (HR 2.445, 95% CI 1.565-3.821, p < 0.001) and OS (HR 2.139, 95% CI 1.180-3.878, p = 0.012) instead of novel classification of IADC predominant patterns. No difference existed between SOL/MIP predominant and minor patterns. In addition, age > 60, smoking, post-chemotherapy and T1b were all indicating poorer RFS and smoking was also related with worse OS. The c-indexes of nomograms were 0.723 for RFS (95% CI, 0.662-0.784) and 0.703 for OS (95% CI, 0.629-0.777) respectively.Conclusions: Once the pT1N0M0 IADC harboring SOL/MIP, it strongly indicated the worse clinical recurrence and survival outcome, no matter whether the SOL and/or MIP was predominant. Smoking was correlated with worse prognosis for those patients. Age > 60 and stage T1b also indicated poorer RFS. Whether post-chemotherapy was harmful to pT1N0M0 IADC patients needed further research. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study was designed to find out the potential indications of completion lobectomy (CL) during wedge resection (WR) operation among patients with lung adenocarcinoma (ADC) ≤3 cm, by the use of Shanghai Chest Hospital Lung Cancer Database. Patients and methods: There were totally 1938 patients in this study, including 746 WRs and 1192 CLs. The propensity score matching (PSM) was performed to minimize the effect of confounders. Univariable and multivariable cox regressions were analyzed to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS). Subgroup analysis and Kaplan-Meier survival curves were performed if necessary. Results: The 5-year RFS (86.1 vs 91.5%, p = 0.001 for unmatched group; 84 v 92%, p < 0.001 for PSM group) and OS (83.6 vs 91.7%, p < 0.001 for unmatched group; 81.6 vs 88.2%, p < 0.001 for PSM group) all indicated a better prognosis when conducting CL. Subgroup analysis suggested that WR was appropriate for non-invasive ADC. Three prognostic factors (sex, surgical approach and pleural invasion) were correlated with RFS and two (sex and surgical approach) corresponded with OS in invasive ADC through multivariable analysis. Non-lepidic-predominant component showed a better RFS and OS when CL was operated after WR in the subgroup of invasive ADC. Conclusion: CL was an appropriate remediation to WR when the existence of invasive ADC, especially non-lepidic-predominant one. While WR could be applied if non-invasive ADC was confirmed. Whether lepidic-predominant adenocarcinoma was fit for WR needed further study. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to investigate the risk factors of recurrence and survival of clinical stage I lung adenocarcinoma underwent wedge resection by the use of Shanghai Chest Hospital Lung Cancer Database. Patients and methods: A total of 746 patients with clinical stage I adenocarcinoma underwent wedge resection from 2010 to 2015 in our database were included in this study. Univariable and multivariable Cox proportional hazards regression were performed successively to select significant risk factors and then nomograms as well as the concordance indexes for RFS, OS and LCSS were developed, respectively. Kaplan-Meier survival curves were performed if necessary, with the identification of log-rank test. Results: The 5-year RFS, OS and LCSS of clinical stage I adenocarcinoma underwent wedge resection were 86.1, 83.6 and 85.2%, respectively. There were three independent risk factors related with RFS (sex, pathology, pleural invasion), two related with OS (sex, volume ratio) and two with LCSS (sex, volume ratio) with the analysis of Cox regression and were selected to develop nomograms. The C-indexes of RFS, OS and LCSS were 0.767 (95% CI 0.667-0.867), 0.782 (95% CI 0.660-0.904) and 0.794 (95% CI 0.669-0.919), respectively. Lymphadenectomy did not show differences statistically but had tendencies of better RFS, OS and LCSS among the subgroup of invasive adenocarcinoma. Conclusion: Sex, pathology and pleural invasion could be recommended as criteria for clinical stage I adenocarcinoma undergoing wedge resection. And the larger the wedge volume and/or the smaller the tumor volume was, the better OS and LCSS were. If the volume ratio reached 10:1 or more, the survival rate was approximately 90% for both OS and LCSS. Whether lymphadenectomy was necessary for WR, especially in invasive adenocarcinoma, needed further research. [ABSTRACT FROM AUTHOR]

Purpose: Controversy remains exist for the effect of adjuvant chemotherapy (ACT) among stage IB lung adenocarcinoma patients. This study aimed to investigate the predictive value of the current lung adenocarcinoma classification system on benefit of ACT among patients with stage IB lung adenocarcinoma. Methods: A total of 928 pathological stage IB invasive adenocarcinoma patients with R0 resection were included in this study. Based on the predominant growth pattern present in the tumor, invasive adenocarcinomas with mixed histologic components were classified into five subtypes: lepidic (LEP), acinar (ACN), papillary (PAP), micropapillary (MIP) and solid (SOL). These five histologic subtypes were collapsed into three groups (LEP, ACN/PAP and SOL/MIP). Disease-free survival (DFS) and overall survival (OS) were analyzed to evaluate benefit from ACT in patients with different histologic patterns using the Kaplan-Meier approach and multivariable Cox models. Results: For all stage IB invasive adenocarcinoma patients, SOL/MIP subgroup presented the worst prognosis, and LEP subgroup showed approximately 100 % 5-year survival. ACT was associated with a better DFS (HR, 0.70; 95 % CI 0.51-0.96, p = .026) for all stage IB patients. In SOL/MIP subgroup, patients could benefit from ACT for a significant improved DFS (HR, 0.81; 95 % CI 0.49-1.35; p = .030), but not for OS (HR, 0.39; 95 % CI 0.12-1.30, p = .111). In ACN/PAP subgroup, there was no significant benefit from ACT for both DFS (HR, 0.76; 95 % CI 0.54-1.08, p = .125) and OS (HR, 0.81; 95 % CI 0.49-1.35, p = .421). Conclusions: SOL/MIP predominant pattern was predictive for ACT benefit for DFS among invasive lung adenocarcinoma patients in stage IB. [ABSTRACT FROM AUTHOR]

Purpose: The correlations between histological, clinical features and prognosis of stage I invasive mucinous adenocarcinoma (IMA) have not been thoroughly studied for its rare incidence. This study aimed to compare the prognosis among IMA with different percentage of mucinous component and the effect of adjuvant chemotherapy on IMA patients. Methods: A total of 145 stage I IMA and 3536 invasive nonmucinous adenocarcinoma patients with R0 resection were included. Based on the percentage of mucinous pattern presented in tumor, IMA were classified into two subgroups: pure mucinous (>90 % invasive mucinous pattern) and mixed mucinous/nonmucinous (≥10 % of each histologic component). Invasive nonmucinous adenocarcinomas were classified into three subgroups: lepidic (LEP), acinar/papillary (ACN/PAP) and solid/micropapillary (SOL/MIP). Disease-free survival (DFS) and overall survival (OS) were assessed and compared among IMA and invasive nonmucinous patients. Results: For IMA patients, DFS ( p = 0.003) was worse for mixed mucinous/nonmucinous compared with pure mucinous subgroup, OS ( p = 0.514) was not prognostically different between two groups. There were no significant difference for DFS ( p = 0.428) and OS ( p = 0.232) between IMA and invasive nonmucinous adenocarcinoma. However, statistical significance were seen for DFS ( p < 0.001) and OS ( p < 0.001) between 5 major histological subgroups: LEP and pure IMA showed excellent prognosis, mixed mucinous/nonmucinous IMA and SOL/MIP subtypes presented the worst prognosis. No significant survival benefit from adjuvant chemotherapy for IMA patients. Conclusions: Mixed mucinous/nonmucinous IMA had a worse DFS compared with pure mucinous. Early stage IMA could not benefit from adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]