Journal
JOURNAL OF THORACIC ONCOLOGY
Volume 13, Issue 12, Pages 1919-1929Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jtho.2018.08.2022
Keywords
Lung adenocarcinoma; Invasive tumor size; Consolidation tumor size; Lung cancer-specific death; Recurrence
Categories
Funding
- National Institutes of Health [R01 CA236615, P30 CA008748]
- US Department of Defense [CA170630, BC132124, LC160212]
- Joanne and John DallePezze Foundation
- Derfner Foundation
- Commonwealth Foundation for Cancer Research
- Experimental Therapeutics Center of Memorial Sloan Kettering Cancer Center
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Introduction: The eighth edition of the TNM staging system included the proposal that the T descriptor be determined according to the invasive component, excluding lepidic component, for nonmucinous lung adenocarcinomas. We sought to conduct a clinicopathologic comparative analysis of the newly proposed classification using invasive size versus total tumor size. Methods: Patients who underwent lung resection for primary lung adenocarcinoma with pathologic stage (p-Stage) I-IIA (based on total size [t]) were reviewed (n = 1704). Pathologic invasive size was measured, and tumors were reclassified using invasive size (i). Cumulative incidence of recurrence and lung cancer-specific cumulative incidence of death were analyzed using a competing-risks approach. Prognostic discrimination by p-Stage(t) and p-Stage(i) was evaluated using a concordance index (C-index). Results: The use of invasive size resulted in downstaging in 377 of 1704 patients (22%), with twice as many patients with p-Stage IA1 (IA1[i] versus IA1[t]: 389 [23%] versus 195 [11%]). However, outcomes were similar between the two groups (IA1[i] versus IA1[t]: 5-year cumulative incidence of recurrence, 11% versus 13%; 5-year lung cancer-specific cumulative incidence of death, 5% versus 7%). Prognostic discrimination by p-Stage(i) was better than by p-Stage(t) (Cindex for p-Stage[i] versus p-Stage[t]: recurrence, 0.614 versus 0.593; lung cancer-specific death, 0.634 versus 0.621). Conclusions: When invasive size, rather than total size, was used for the T descriptor, a larger number of patients were classified with a favorable prognosis (p-Stage IA1) and better prognostic discrimination of p-Stage I-IIA non-mucinous lung adenocarcinomas was achieved. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
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