Procedure-Specific Risk Prediction for Recurrence in Patients Undergoing Lobectomy or Sublobar Resection for Small (≤2 cm) Lung Adenocarcinoma: An International Cohort Analysis.
Procedure-Specific Risk Prediction for Recurrence in Patients Undergoing Lobectomy or Sublobar Resection for Small (≤2 cm) Lung Adenocarcinoma: An International Cohort Analysis.
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DOI：
10.1016/j.jtho.2018.09.008
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发表时间：
2019-01
期刊：
影响因子：
--
通讯作者：
Adusumilli PS
中科院分区：
文献类型：
--
作者：
Bains S;Eguchi T;Warth A;Yeh YC;Nitadori JI;Woo KM;Chou TY;Dienemann H;Muley T;Nakajima J;Shinozaki-Ushiku A;Wu YC;Lu S;Kadota K;Jones DR;Travis WD;Tan KS;Adusumilli PS
开发和验证早期肺腺癌（ADC）切除术后复发的手术特异性风险预测，并研究风险预测在识别可能受益于辅助化疗（ACT）的患者中的效用。在因小（≤2 cm）肺ADC而接受切除术的患者中（肺叶切除术，557;肺叶切除术，352），通过竞争风险方法评估了临床病理变量与复发风险之间的相关性。基于复发的多变量回归，开发了手术特定风险预测。使用来自日本、中国台湾和德国的队列（N=708）进行外部验证。风险预测的准确性采用一致性指数（C指数）进行衡量。我们将肺叶切除术风险预测方法应用于倾向评分匹配的II-III期疾病患者队列（匹配后n=316），并比较了低或高风险评分组之间的肺癌特异性生存率。微乳头型、实体型、淋巴管浸润和坏死参与了肺叶切除术后的风险预测，微乳头型、通过空气间隙扩散、淋巴管浸润和肺叶下切除术后的坏死参与了风险预测。内部和外部验证均显示出良好的区分度（肺叶切除术和肺叶下切除术的C指数：内部，0.77和0.75;外部，0.73和0.79）。在II-III期倾向评分匹配队列中，在高风险患者中，ACT显著降低肺癌特异性死亡的风险（亚危险比0.43，p=0.001），但在低风险患者中则不然。对切除小肺ADC患者的手术特异性风险预测可用于更好地对患者进行分类和分层，以进行进一步干预。
To develop and validate procedure-specific risk prediction for recurrence following resection for early-stage lung adenocarcinoma (ADC) and investigate risk prediction utility in identifying patients who may benefit from adjuvant chemotherapy (ACT). In patients who underwent resection for small (≤2 cm) lung ADC (lobectomy, 557; sublobar resection, 352), an association between clinicopathological variables and risk of recurrence was assessed by a competing risks approach. Procedure-specific risk prediction was developed based on multivariable regression for recurrence. External validation was conducted using cohorts (N=708) from Japan, Taiwan, and Germany. The accuracy of risk prediction was measured using a concordance index (C-index). We applied the lobectomy risk prediction approach to a propensity score–matched cohort of patients with stage II-III disease (n=316, after matching) with or without ACT and compared lung cancer-specific survival between groups among low or high-risk scores. Micropapillary pattern, solid pattern, lymphovascular invasion, and necrosis were involved in the risk prediction following lobectomy, and micropapillary pattern, spread through air spaces, lymphovascular invasion, and necrosis following sublobar-resection. Both internal and external validation showed good discrimination (C-index in lobectomy and sublobar resection: internal, 0.77 and 0.75; and external, 0.73 and 0.79). In the stage II-III propensity score–matched cohort, among high-risk patients, ACT significantly reduced the risk of lung cancer–specific death (subhazard ratio 0.43, p=0.001), but not among low-risk patients. Procedure-specific risk prediction for patients with resected small lung ADC can be used to better prognosticate and stratify patients for further interventions.
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