Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Thoracic Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan.
J Thorac Oncol. 2019 Jan;14(1):72-86. doi: 10.1016/j.jtho.2018.09.008. Epub 2018 Sep 22.
This work was performed 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).
In patients who underwent resection for small (≤2 cm) lung ADC (lobectomy, 557; sublobar resection, 352), an association between clinicopathologic 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. 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.
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 (concordance index in lobectomy and sublobar resection: internal, 0.77 and 0.75, respectively; and external, 0.73 and 0.79, respectively). 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.
Procedure-specific risk prediction for patients with resected small lung ADC can be used to better prognosticate and stratify patients for further interventions.
本研究旨在开发和验证早期肺腺癌（ADC）切除术后复发的特定手术风险预测，并探讨风险预测在识别可能从辅助化疗（ACT）中获益的患者方面的作用。
在接受小（≤2cm）肺 ADC 切除术的患者（肺叶切除术，557 例；亚肺叶切除术，352 例）中，采用竞争风险方法评估临床病理变量与复发风险之间的关联。基于多变量回归分析，制定了特定手术的复发风险预测。使用来自日本、中国台湾和德国的队列（n=708）进行外部验证。采用一致性指数评估风险预测的准确性。我们将肺叶切除术风险预测方法应用于具有 II-III 期疾病（n=316，经匹配后）的倾向评分匹配队列，比较有无 ACT 情况下低风险或高风险评分组之间的肺癌特异性生存率。
微乳头模式、实体模式、脉管侵犯和坏死与肺叶切除术后的风险预测有关，而微乳头模式、空气空间扩散、脉管侵犯和坏死与亚肺叶切除术后的风险预测有关。内部和外部验证均显示出良好的区分度（肺叶切除术和亚肺叶切除术的一致性指数分别为 0.77 和 0.75；内部和外部验证分别为 0.73 和 0.79）。在 II-III 期倾向评分匹配队列中，高风险患者中 ACT 显著降低了肺癌特异性死亡风险（亚风险比 0.43，p=0.001），而低风险患者则没有。
对接受切除治疗的小肺 ADC 患者进行特定手术的风险预测，可用于更好地预测预后和分层患者以进行进一步干预。
