Fick Cameron N, Dunne Elizabeth G, Vanstraelen Stijn, Toumbacaris Nicolas, Tan Kay See, Rocco Gaetano, Molena Daniela, Huang James, Park Bernard J, Rekhtman Natasha, Travis William D, Chaft Jamie E, Bott Matthew J, Rusch Valerie W, Adusumilli Prasad S, Sihag Smita, Isbell James M, Jones David R
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2025 Feb;169(2):436-444.e6. doi: 10.1016/j.jtcvs.2024.05.009. Epub 2024 May 22.
There is a lack of knowledge regarding the use of prognostic features in stage I lung adenocarcinoma (LUAD). Thus, we investigated clinicopathologic features associated with recurrence after complete resection for stage I LUAD.
We performed a retrospective analysis of patients with pathologic stage I LUAD who underwent R0 resection from 2010 to 2020. Exclusion criteria included history of lung cancer, induction or adjuvant therapy, noninvasive or mucinous LUAD, and death within 90 days of surgery. Fine and Gray competing-risk regression assessed associations between clinicopathologic features and disease recurrence.
In total, 1912 patients met inclusion criteria. Most patients (1565 [82%]) had stage IA LUAD, and 250 developed recurrence: 141 (56%) distant and 109 (44%) locoregional only. The 5-year cumulative incidence of recurrence was 12% (95% CI, 11%-14%). Higher maximum standardized uptake value of the primary tumor (hazard ratio [HR], 1.04), sublobar resection (HR, 2.04), higher International Association for the Study of Lung Cancer grade (HR, 5.32 [grade 2]; HR, 7.93 [grade 3]), lymphovascular invasion (HR, 1.70), visceral pleural invasion (HR, 1.54), and tumor size (HR, 1.30) were independently associated with a hazard of recurrence. Tumors with 3 to 4 high-risk features had a higher cumulative incidence of recurrence at 5 years than tumors without these features (30% vs 4%; P < .001).
Recurrence after resection for stage I LUAD remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients at high risk of recurrence and should be considered when assessing the prognosis of patients with stage I disease.
目前对于I期肺腺癌（LUAD）预后特征的应用缺乏了解。因此，我们研究了I期LUAD完整切除术后与复发相关的临床病理特征。
我们对2010年至2020年接受R0切除的病理I期LUAD患者进行了回顾性分析。排除标准包括肺癌病史、诱导或辅助治疗、非浸润性或黏液性LUAD以及术后90天内死亡。精细和灰色竞争风险回归评估了临床病理特征与疾病复发之间的关联。
共有1912例患者符合纳入标准。大多数患者（1565例[82%]）为IA期LUAD，250例出现复发：141例（56%）远处复发，109例（44%）仅局部区域复发。5年累积复发率为12%（95%CI，11%-14%）。原发肿瘤的最大标准化摄取值较高（风险比[HR]，1.04）、肺叶下切除（HR，2.04）、国际肺癌研究协会分级较高（HR，5.32[2级]；HR，7.93[3级]）、淋巴管浸润（HR，1.70）、脏层胸膜浸润（HR，1.54）和肿瘤大小（HR，1.30）与复发风险独立相关。具有3至4个高危特征的肿瘤5年累积复发率高于无这些特征的肿瘤（30%对4%；P<.001）。
I期LUAD切除术后复发仍是部分患者面临的问题。常用的临床病理特征可用于定义复发高危患者，在评估I期疾病患者的预后时应予以考虑。
