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Predicting the recurrence risk factors and clinical outcomes of peripheral pulmonary adenocarcinoma ≤3 cm with wedge resection

Journal of Cancer Research and Clinical Oncology volume 143, pages 1043–1051 (2017)Cite this article

Abstract

Purpose

This study was designed to investigate the risk factors of recurrence and survival of clinical stage I lung adenocarcinoma underwent wedge resection by the use of Shanghai Chest Hospital Lung Cancer Database.

Patients and methods

A total of 746 patients with clinical stage I adenocarcinoma underwent wedge resection from 2010 to 2015 in our database were included in this study. Univariable and multivariable Cox proportional hazards regression were performed successively to select significant risk factors and then nomograms as well as the concordance indexes for RFS, OS and LCSS were developed, respectively. Kaplan–Meier survival curves were performed if necessary, with the identification of log-rank test.

Results

The 5-year RFS, OS and LCSS of clinical stage I adenocarcinoma underwent wedge resection were 86.1, 83.6 and 85.2%, respectively. There were three independent risk factors related with RFS (sex, pathology, pleural invasion), two related with OS (sex, volume ratio) and two with LCSS (sex, volume ratio) with the analysis of Cox regression and were selected to develop nomograms. The C-indexes of RFS, OS and LCSS were 0.767 (95% CI 0.667–0.867), 0.782 (95% CI 0.660–0.904) and 0.794 (95% CI 0.669–0.919), respectively. Lymphadenectomy did not show differences statistically but had tendencies of better RFS, OS and LCSS among the subgroup of invasive adenocarcinoma.

Conclusion

Sex, pathology and pleural invasion could be recommended as criteria for clinical stage I adenocarcinoma undergoing wedge resection. And the larger the wedge volume and/or the smaller the tumor volume was, the better OS and LCSS were. If the volume ratio reached 10:1 or more, the survival rate was approximately 90% for both OS and LCSS. Whether lymphadenectomy was necessary for WR, especially in invasive adenocarcinoma, needed further research.

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Abbreviations

PI:

Pleural invasion

LVI:

Lymphovascular invasion

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Author information

Affiliations

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

    Yiyang Wang, Rui Wang, Heng Zhao, Jizhuang Luo, Jiajie Zheng, Tianxiang Chen & Qingyuan Huang

  2. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China

    Difan Zheng, Yihua Sun & Haiquan Chen

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

    Baohui Han

  4. Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Jie Zhang

  5. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Haiquan Chen

  6. Institutes of Biomedical Sciences, Fudan University, Shanghai, China

    Haiquan Chen

Authors
  1. Yiyang Wang
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  2. Rui Wang
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  3. Difan Zheng
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  4. Baohui Han
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  5. Jie Zhang
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  6. Heng Zhao
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  7. Jizhuang Luo
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  8. Jiajie Zheng
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  9. Tianxiang Chen
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  10. Qingyuan Huang
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  11. Yihua Sun
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  12. Haiquan Chen
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Corresponding author

Correspondence to Haiquan Chen.

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Conflict of interest

The authors declare no conflict of interest.

Funding information

This work was supported by the National Natural Science Foundation of China (81572253, 81330056, 81401891, 81422029 and 81372525).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from each patient to allow their biological samples to be genetically analyzed.

Additional information

Y. Wang and R. Wang contributed equally to this work.

Appendix

Appendix

See Figs. 3 and 4.

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Wang, Y., Wang, R., Zheng, D. et al. Predicting the recurrence risk factors and clinical outcomes of peripheral pulmonary adenocarcinoma ≤3 cm with wedge resection. J Cancer Res Clin Oncol 143, 1043–1051 (2017). https://doi.org/10.1007/s00432-016-2337-7

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  • DOI: https://doi.org/10.1007/s00432-016-2337-7

Keywords

  • Wedge resection
  • Stage I
  • Lung adenocarcinoma
  • Nomogram