Prognostic Factors for Patients with Stage Ⅰ<sub>A</sub> Non-small Cell Lung Cancer after Operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FENGHong-xiang , ZHANGZhen-rong , GUOYong-qing , SHIbin , SONGZhi-yi , TIANYan-chu , LIANGChao-yang ,  LIUDe-ruo

Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, P. R. China;

Corresponding author：

LIUDe-ruo, Email: deruoliu@vip.sina.com

Keywords：

Non-small cell lung cancer; Prognosis; Cancer vessel invasion

DOI：

10.7507/1007-4848.20160232

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Objective To identify prognostic factors for patients with non-small cell lung cancer (NSCLC) in pathologic stage Ⅰ_A after operation. Methods We retrospectively analyzed the clinical data of 138 patients, who underwent surgical resection at our institution for stage Ⅰ_A NSCLC. There were 81 males and 57 females with a median age of 61 years (ranged from 37 to 80 years). The in-hospital data and follow-up results were collected. Survival curve was generated by Kaplan-Meier method. Univariate and multivariate analyses of disease-free survival (DFS) were performed. Results The follow-up time was from 9 to 90 months with a median of 59 months. During the follow-up, recurrence and metastasis occurred in 14 patients, local relapse in 8 patients, bone and ipsilateral lymph node metastasis occurred in one patient. Univariate analysis showed that DFS of patients was related with blood vessel or lymphatic invasion (P=0.017), poor histological differentiation (P=0.043), and tumor diameter ≥2 cm (P=0.017), respectively. Multivariate analysis demonstrated that tumor diameter ≥2 cm (P=0.026) and blood vessel or lymphatic invasion (P=0.011) were independent prognostic factors for DFS of stage Ⅰ_A NSCLC patients after operation. Conclusion Our analyses indicate vessel involvement and the tumor diameter are independent indicators of DFS in patients with pathologic stage Ⅰ_A NSCLC after operation.

Citation： FENG Hong-xiang, ZHANG Zhen-rong, GUO Yong-qing, SHI bin, SONG Zhi-yi, TIAN Yan-chu, LIANG Chao-yang, LIU De-ruo. Prognostic Factors for Patients with Stage Ⅰ_A Non-small Cell Lung Cancer after Operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(10): 969-973. doi: 10.7507/1007-4848.20160232 Copy

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2.	Sawabata N, Asamura H, Goya T, et al. Japanese Lung Cancer Registry Study: first prospective enrollment of a large number of surgical and nonsurgical cases in 2002. J Thorac Oncol, 2010, 5(9): 1369-1375.
3.	Agarwal M, Brahmanday G, Chmielewski GW, et al. Age, tumor size, type of surgery, and gender predict survival in early stage (stage I and II) non-small cell lung cancer after surgical resection. Lung Cancer, 2010, 68(3): 398-402.
4.	Kawai H, Tada A, Kawahara M, et al. Smoking history before surgery and prognosis in patients with stage IA non-small-cell lung cancer—a multicenter study. Lung Cancer, 2005, 49(1): 63-70.
5.	Matsuguma H, Nakahara R, Igarashi S, et al. Pathologic stage I non-small cell lung cancer with high levels of preoperative serum carcinoembryonic antigen: Clinicopathologic characteristics and prognosis. J Thorac Cardiovasc Surg, 2008, 135(1): 44-49.
6.	Maeda R, Yoshida J, Ishii G, et al. Long-term survival and risk factors for recurrence in stage I non-small cell lung cancer patients with tumors up to 3 cm in maximum dimension. Chest, 2010, 138(2): 357-362.
7.	Ruffini E, Asioli S, Filosso PL, et al. Significance of the presence of microscopic vascular invasion after complete resection of stage I-II pT1-T2N0 non-small cell lung cancer and its relation with T-size categories: did the 2009 7th edition of the TNM staging system miss something?. J Thorac Oncol, 2011, 6(2): 319-326.
8.	Okada M, Sakamoto T, Nishio W, et al. Characteristics and prognosis of patients after resection of nonsmall cell lung carcinoma measuring 2 cm or less in greatest dimension. Cancer, 2003, 98(3): 535-541.
9.	Funai K, Sugimura H, Morita T, et al. Lymphatic vessel invasion is a significant prognostic indicator in stage IA lung adenocarcinoma. Ann Surg Oncol, 2011, 18(10): 2968-2972.
10.	Tsuchiya T, Hashizume S, Akamine S, et al. Upstaging by vessel invasion improves the pathology staging system of non-small cell lung cancer. Chest, 2007, 132(1): 170-177.
11.	刘复生, 刘彤华, 主编. 肿瘤病理学. 北京:北京医科大学中国协和医科大学联合出版社, 1997. 20.
12.	Ito T, Murakawa T, Sato H, et al. Simple preoperative computed tomography image analysis shows good predictive performance for pathological vessel invasion in clinical stage IA non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 2012, 15(4): 633-638.
13.	Shoji F, Haro A, Yoshida T, et al. Prognostic significance of intratumoral blood vessel invasion in pathologic stage IA non-small cell lung cancer. Ann Thorac Surg, 2010, 89(3): 864-869.
14.	Harada M, Hato T, Horio H. Intratumoral lymphatic vessel involvement is an invasive indicator of completely resected pathologic stage I non-small cell lung cancer. J Thorac Oncol, 2011, 6(1): 48-54.
15.	Mollberg NM, Bennette C, Howell E, et al. Lymphovascular invasion as a prognostic indicator in stage I non-small cell lung cancer: a systematic review and meta-analysis. Ann Thorac Surg, 2014, 97(3): 965-971.
16.	Wang J, Wang B, Zhao W, et al. Clinical significance and role of lymphatic vessel invasion as a major prognostic implication in non-small cell lung cancer: a meta-analysis. PloS One, 2012, 7(12): e52704.
17.	Ito T, Murakawa T, Sato H, et al. Simple preoperative computed tomography image analysis shows good predictive performance for pathological vessel invasion in clinical stage IA non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 2012, 15(4): 633-638.
18.	周莹, 刘士远, 李琼, 等. 临床 Ⅰ_A期周围型肺腺癌病理性脉管浸润与其薄层CT征象的相关性研究. 中华放射学杂志, 2015, 49(4), 259-263.
19.	章必成, 张亚飞, 高建飞. 脉管瘤栓能改变非小细胞肺癌TNM分期吗?. 医学争鸣, 2012, 3(3): 39-40.
20.	Tsuchiya T, Akamine S, Muraoka M, et al. Stage IA non-small cell lung cancer: vessel invasion is a poor prognostic factor and a new target of adjuvant chemotherapy. Lung Cancer, 2007, 56(3): 341-348.
21.	Chang M Y, Mentzer SJ, Colson Y L, et al. Factors predicting poor survival after resection of stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2007, 134(4): 850-856.
22.	Rami-Porta R, Ball D, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol, 2007, 2(7): 593-602.

1. Poleri C, Morero J L, Nieva B, et al. Risk of recurrence in patients with surgically resected stage I non-small cell lung carcinoma: histopathologic and immunohistochemical analysis. Chest, 2003, 123(6): 1858-1867.
2. Sawabata N, Asamura H, Goya T, et al. Japanese Lung Cancer Registry Study: first prospective enrollment of a large number of surgical and nonsurgical cases in 2002. J Thorac Oncol, 2010, 5(9): 1369-1375.
3. Agarwal M, Brahmanday G, Chmielewski GW, et al. Age, tumor size, type of surgery, and gender predict survival in early stage (stage I and II) non-small cell lung cancer after surgical resection. Lung Cancer, 2010, 68(3): 398-402.
4. Kawai H, Tada A, Kawahara M, et al. Smoking history before surgery and prognosis in patients with stage IA non-small-cell lung cancer—a multicenter study. Lung Cancer, 2005, 49(1): 63-70.
5. Matsuguma H, Nakahara R, Igarashi S, et al. Pathologic stage I non-small cell lung cancer with high levels of preoperative serum carcinoembryonic antigen: Clinicopathologic characteristics and prognosis. J Thorac Cardiovasc Surg, 2008, 135(1): 44-49.
6. Maeda R, Yoshida J, Ishii G, et al. Long-term survival and risk factors for recurrence in stage I non-small cell lung cancer patients with tumors up to 3 cm in maximum dimension. Chest, 2010, 138(2): 357-362.
7. Ruffini E, Asioli S, Filosso PL, et al. Significance of the presence of microscopic vascular invasion after complete resection of stage I-II pT1-T2N0 non-small cell lung cancer and its relation with T-size categories: did the 2009 7th edition of the TNM staging system miss something?. J Thorac Oncol, 2011, 6(2): 319-326.
8. Okada M, Sakamoto T, Nishio W, et al. Characteristics and prognosis of patients after resection of nonsmall cell lung carcinoma measuring 2 cm or less in greatest dimension. Cancer, 2003, 98(3): 535-541.
9. Funai K, Sugimura H, Morita T, et al. Lymphatic vessel invasion is a significant prognostic indicator in stage IA lung adenocarcinoma. Ann Surg Oncol, 2011, 18(10): 2968-2972.
10. Tsuchiya T, Hashizume S, Akamine S, et al. Upstaging by vessel invasion improves the pathology staging system of non-small cell lung cancer. Chest, 2007, 132(1): 170-177.
11. 刘复生, 刘彤华, 主编. 肿瘤病理学. 北京:北京医科大学中国协和医科大学联合出版社, 1997. 20.
12. Ito T, Murakawa T, Sato H, et al. Simple preoperative computed tomography image analysis shows good predictive performance for pathological vessel invasion in clinical stage IA non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 2012, 15(4): 633-638.
13. Shoji F, Haro A, Yoshida T, et al. Prognostic significance of intratumoral blood vessel invasion in pathologic stage IA non-small cell lung cancer. Ann Thorac Surg, 2010, 89(3): 864-869.
14. Harada M, Hato T, Horio H. Intratumoral lymphatic vessel involvement is an invasive indicator of completely resected pathologic stage I non-small cell lung cancer. J Thorac Oncol, 2011, 6(1): 48-54.
15. Mollberg NM, Bennette C, Howell E, et al. Lymphovascular invasion as a prognostic indicator in stage I non-small cell lung cancer: a systematic review and meta-analysis. Ann Thorac Surg, 2014, 97(3): 965-971.
16. Wang J, Wang B, Zhao W, et al. Clinical significance and role of lymphatic vessel invasion as a major prognostic implication in non-small cell lung cancer: a meta-analysis. PloS One, 2012, 7(12): e52704.
17. Ito T, Murakawa T, Sato H, et al. Simple preoperative computed tomography image analysis shows good predictive performance for pathological vessel invasion in clinical stage IA non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 2012, 15(4): 633-638.
18. 周莹, 刘士远, 李琼, 等. 临床 Ⅰ_A期周围型肺腺癌病理性脉管浸润与其薄层CT征象的相关性研究. 中华放射学杂志, 2015, 49(4), 259-263.
19. 章必成, 张亚飞, 高建飞. 脉管瘤栓能改变非小细胞肺癌TNM分期吗?. 医学争鸣, 2012, 3(3): 39-40.
20. Tsuchiya T, Akamine S, Muraoka M, et al. Stage IA non-small cell lung cancer: vessel invasion is a poor prognostic factor and a new target of adjuvant chemotherapy. Lung Cancer, 2007, 56(3): 341-348.
21. Chang M Y, Mentzer SJ, Colson Y L, et al. Factors predicting poor survival after resection of stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2007, 134(4): 850-856.
22. Rami-Porta R, Ball D, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol, 2007, 2(7): 593-602.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic Factors for Patients with Stage Ⅰ_A Non-small Cell Lung Cancer after Operation

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic Factors for Patients with Stage ⅠA Non-small Cell Lung Cancer after Operation

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Prognostic Factors for Patients with Stage Ⅰ_A Non-small Cell Lung Cancer after Operation