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Annals of Surgical Oncology

, Volume 22, Issue 12, pp 4089–4097 | Cite as

Recurrence Risk-Scoring Model for Stage I Adenocarcinoma of the Lung

  • Hee Chul Yang
  • Hyeong Ryul Kim
  • Sanghoon Jheon
  • Kwhanmien Kim
  • Sukki Cho
  • Soyeon Ahn
  • Ho-Young Lee
  • Jin-Haeng Chung
  • Kyung Young Chung
  • Mi Kyung Bae
  • Seong Yong Park
  • Dong Kwan Kim
  • Se Hoon Choi
  • Jae Ill Zo
  • Moon Soo Kim
  • Jong Mog Lee
  • Jhingook Kim
  • Young Mog Shim
  • Kook Joo Na
  • Ju Sik Yun
  • Jae Yong Park
Thoracic Oncology

Abstract

Purpose

The aim of this retrospective, multicenter study was to develop a recurrence risk-scoring model in patients with curatively resected stage I lung adenocarcinoma (ADC).

Methods

Clinicopathologic and outcome data for a development cohort of 1,700 patients with pathologic stage I ADC from four institutions resected between January 2000 and December 2009 were evaluated. A phantom study was performed for correction of inter-institutional differences in positron emission tomography-standardized uptake value (PET-SUV). A nomogram for recurrence prediction was developed using Cox proportional hazards regression. This model was validated in a cohort of 460 patients in two other hospitals. The recurrence rate was 21.0 % for the development cohort and 22.1 % for the validation cohort.

Results

In multivariable analysis, three independent predictors for recurrence were identified: pathologic tumor size (hazard ratio [HR] 1.03, 95 % CI 1.017–1.048; p < 0.001), corrected PET-SUV (HR 1.08, 95 % CI 1.051–1.105; p < 0.001), and lymphovascular invasion (HR 1.65, 95 % CI 1.17–2.33; p = 0.004). The nomogram was made based on these factors and a calculated risk score was accorded to each patient. Kaplan–Meier analysis of the development cohort showed a 5-year recurrence-free survival (RFS) of 83 % (95 % CI 0.80–0.86) in low-risk patients and 59 % (95 % CI 0.54–0.66) in high-risk patients with the highest 30 percentile scores. The concordance index was 0.632 by external validation.

Conclusions

This recurrence risk-scoring model can be used to predict the RFS for pathologic stage I ADC patients using the above three easily measurable factors. High-risk patients need close follow-up and can be candidates for adjuvant chemotherapy.

Keywords

Locoregional Recurrence Validation Cohort Phantom Study Concordance Index Pathologic Tumor Size 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was supported by the R&D program of the Korean Ministry of Knowledge and Economy/Korea Evaluation Institute of Industrial Technology (MKE/KEIT) (10040393; Development and commercialization of molecular diagnostic technologies for lung cancer through clinical validation) and the Korean Foundation for Cancer Research (CB-2011-02-01). The authors are indebted to J. Patrick Barron, Professor Emeritus, Tokyo Medical University and Adjunct Professor, Seoul National University Bundang Hospital for his pro bono editing of this manuscript.

Conflicts of interest

No conflicts of interest were declared by any of the authors.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Hee Chul Yang
    • 1
  • Hyeong Ryul Kim
    • 6
  • Sanghoon Jheon
    • 1
  • Kwhanmien Kim
    • 1
  • Sukki Cho
    • 1
  • Soyeon Ahn
    • 2
  • Ho-Young Lee
    • 3
  • Jin-Haeng Chung
    • 4
  • Kyung Young Chung
    • 5
  • Mi Kyung Bae
    • 5
  • Seong Yong Park
    • 5
  • Dong Kwan Kim
    • 6
  • Se Hoon Choi
    • 6
  • Jae Ill Zo
    • 7
  • Moon Soo Kim
    • 7
  • Jong Mog Lee
    • 7
  • Jhingook Kim
    • 8
  • Young Mog Shim
    • 8
  • Kook Joo Na
    • 9
  • Ju Sik Yun
    • 9
  • Jae Yong Park
    • 10
  1. 1.Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Medical Research Collaborating Center, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of Nuclear Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  4. 4.Department of Pathology, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  5. 5.Department of Thoracic and Cardiovascular SurgeryYonsei University, College of MedicineSeoulSouth Korea
  6. 6.Department of Thoracic and Cardiovascular Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineUlsanSouth Korea
  7. 7.Center for Lung Cancer, Research Institute and HospitalNational Cancer CenterGoyangSouth Korea
  8. 8.Department of Thoracic and Cardiovascular Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  9. 9.Lung and Esophageal Cancer ClinicChonnam National University Hwasun HospitalHwasunSouth Korea
  10. 10.Lung Cancer CenterKyungpook National University Medical CenterDaeguSouth Korea

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