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. 2018 Mar;155(3):1212-1224.e3.
doi: 10.1016/j.jtcvs.2017.09.151. Epub 2017 Nov 13.

Factors associated with distant recurrence following R0 lobectomy for pN0 lung adenocarcinoma

Whitney S Brandt  1 , Ilies Bouabdallah  1 , Kay See Tan  2 , Bernard J Park  1 , Prasad S Adusumilli  1 , Daniela Molena  1 , Manjit S Bains  1 , James Huang  1 , James M Isbell  1 , Matthew J Bott  1 , David R Jones  3
Affiliations

Factors associated with distant recurrence following R0 lobectomy for pN0 lung adenocarcinoma

Whitney S Brandt et al. J Thorac Cardiovasc Surg. 2018 Mar.

Abstract

Objective: We investigated factors associated with distant recurrence, disease-free survival (DFS), and overall survival (OS) following R0 lobectomy for pathologic node-negative (pN0) lung adenocarcinoma.

Methods: We performed a retrospective analysis of a prospectively maintained database of patients with pT1-3N0M0 non-small cell lung cancer. Exclusion criteria included metachronous lung cancer, sublobar/incomplete resection, nonadenocarcinoma histology, and induction/adjuvant therapy. The primary outcome was distant recurrence; secondary outcomes were DFS and OS. Associations between variables and outcomes were assessed by Fine-Gray competing-risk regression for distant recurrence and Cox proportional hazard models for DFS and OS.

Results: Of 2392 patients identified with pT1-3N0M0 lung adenocarcinoma, 893 met the inclusion criteria. Median follow-up was 35.0 months (range, 0.1-202 months). Thirteen percent of patients developed recurrence (n = 115), of which 86% (n = 99) were distant. The 5-year cumulative incidence of distant recurrence was 14% (95% confidence interval [CI], 11%-17%). On multivariable analysis, pT2a (hazard ratio [HR], 2.84; 95% CI, 1.56-5.16; P = .001) and pT2b/3 (HR, 6.53; 95% CI, 3.17-13.5; P < .001) tumors were associated with distant recurrence. Recent surgery was associated with decreased distant recurrence (HR, 0.43; 95% CI, 0.20-0.91; P = .028), and lymphovascular invasion was strongly associated with distant recurrence (HR, 1.62; 95% CI, 1.00-2.63; P = .05). DFS was independently associated with pT stage (P < .001) and lymphovascular invasion (P = .004).

Conclusions: In patients undergoing R0 lobectomy with pN0 lung adenocarcinoma, pT stage and lymphovascular invasion were associated with distant recurrence and decreased DFS. These observations support the inclusion of these patients in future clinical trials investigating adjuvant targeted and immunotherapies.

Keywords: lobectomy; lung adenocarcinoma; lymphovascular invasion; pathologic tumor stage; recurrence.

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Conflict of interest statement

Conflicts of interest: All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow diagram. Original population and exclusion criteria used to determine the final cohort of patients.
Figure 2
Figure 2
Cumulative incidence of distant recurrence (CIR-distant). A, The CIR-distant for the entire cohort was 14% (95% confidence interval [CI], 11%–17%). B, Five-year CIR-distant by pathologic tumor (pT) stage and C, lymphovascular invasion (LVI).
Figure 3
Figure 3
Disease-free survival (DFS) (A) and overall survival (OS) (B) by pathologic tumor stage (pT).
Figure 4
Figure 4
Disease-free survival (DFS) (A) and overall survival (OS) (B) by presence versus absence of lymphovascular invasion (LVI).
Figure 5
Figure 5. Central Picture
Cumulative incidence of distant recurrence by pathologic T (pT) stage (N=893).
See this image and copyright information in PMC

Comment in

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