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Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to explore adjuvant chemotherapy (ACT) candidates based on a recurrence risk-scoring model in completely lobectomized stage I patients with lung adenocarcinoma (LAD).

Methods

A retrospective study was performed on 4606 patients (non-ACT group: n = 3514; ACT group: n = 1092) who underwent complete lobectomy for LAD at Shanghai Chest Hospital from 2008 to 2014. The nomogram predicting recurrence-free survival (RFS) was developed in the non-ACT group using Cox proportional hazards regression. The nomogram-based risk score was calculated in the entire cohort. Differences of RFS between the non-ACT and ACT groups were compared as stratified by the risk score. The score cut-off points were determined using the X-tile software.

Results

Six independent predictors, including age, sex, tumor size, pathological subtype, visceral pleural invasion (VPI), and lymphovascular invasion (LVI) were associated with RFS. The nomogram more accurately predicted RFS than the 8th TNM staging {C-index: 0.784 [95% confidence interval (CI) 0.756–0.812] vs. 0.719 (95% CI 0.689–0.749), p = 0.0017}. A significant RFS difference was observed among the low-, intermediate- and high-risk groups (p < 0.0001), as divided by the optimal cut-points of risk score (203 and 244). ACT did not improve RFS for patients at intermediate-risk, or was even detrimental for low-risk patients; however, improved RFS was observed in ACT receivers at high-risk (p = 0.0416). ACT candidates with a risk score ≥ 245 constituted 2.6% of stage I patients.

Conclusions

The nomogram provided an individual prediction of RFS for stage I LAD following lobectomy. High-risk patients (score ≥ 245) may benefit from postoperative ACT.

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Acknowledgment

None.

Funding

This work was supported by the Shanghai Jiao Tong University School of Medicine PhD Student Innovation Fund (No. BXJ201843). The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Jie Qian and Jianlin Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Jie Qian MD, Jianlin Xu MD, PhD, Shuyuan Wang MD, Fangfei Qian MD, Wenjia Yang MD, Bo Zhang MD, Yanwei Zhang MD, PhD, Wei Nie MD, PhD, Yuqing Lou MD, PhD, Jun Lu MD, PhD, Xueyan Zhang MD, PhD, Wei Zhang MD, PhD, Tianqing Chu MD, PhD, Hua Zhong MD, PhD & Baohui Han MD, PhD

  2. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Wentao Fang MD, PhD & Heng Zhao MD, PhD

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  1. Jie Qian MD
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Corresponding author

Correspondence to Baohui Han MD, PhD.

Ethics declarations

Jie Qian, Jianlin Xu, Shuyuan Wang, Fangfei Qian, Wenjia Yang, Bo Zhang, Yanwei Zhang, Wei Nie, Yuqing Lou, Jun Lu, Xueyan Zhang, Wei Zhang, Tianqing Chu, Hua Zhong, Wentao Fang, Heng Zhao, and Baohui Han declare they have no conflicts of interest.

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Qian, J., Xu, J., Wang, S. et al. Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy. Ann Surg Oncol 26, 2392–2400 (2019). https://doi.org/10.1245/s10434-019-07366-z

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