Survival outcomes and prognostic impact of adjuvant chemotherapy in stage IB lung adenocarcinoma with cribriform component.

Abstract

Background: Cribriform morphology is a distinct high-grade pattern associated with aggressive tumor biology and poor survival outcomes in lung adenocarcinoma (LUAD). The potential survival benefits of adjuvant chemotherapy (ACT) for stage IB LUAD containing cribriform components remain undefined. This study aims to investigate the prognostic significance of ACT in patients with stage IB LUAD containing cribriform components.

Methods: This retrospective study enrolled 235 surgically resected LUAD patients with pathologically confirmed stage IB disease from Qilu Hospital of Shandong University. To mitigate selection bias, propensity score matching (PSM) was implemented with 1:1 nearest-neighbor matching. Survival outcomes were compared using Kaplan-Meier methodology with log-rank testing for intergroup comparisons. Univariate and Multivariate Cox proportional hazards models were constructed to identify independent prognostic factors.

Results: Patients were stratified into cribriform-positive and cribriform-negative cohorts based on histologically confirmed cribriform component status, resulting in 67 patients with cribriform components and 168 patients without this histopathological feature. After PSM, 59 pairs of patients were finally included for analysis. The results showed that both the 5-year overall survival (OS) rates (63.5% vs. 84.5%, P = 0.013) and 5-year recurrence-free survival (RFS) rates (58.7% vs. 77.7%, P = 0.033) for cribriform-positive patients were lower than those for cribriform-negative patients. In addition, we further explored whether patients with cribriform components could derive a survival benefit from postoperative ACT. The results indicated that patients receiving ACT demonstrated a significant improvement in 5-year rates of RFS compared to observation-only management (70.2% vs. 38.6%, P = 0.0096). Univariate and multivariate Cox proportional hazards regression analyses identified the resection range (HR = 0.197; 95% CI: 0.061-0.632; P = 0.006), STAS (HR = 2.653; 95% CI: 1.131-6.221; P = 0.025), and ACT (HR = 0.334; 95% CI: 0.151-0.742; P = 0.007) as independent prognostic factors for RFS.

Conclusion: The presence of cribriform components in stage IB LUAD was associated with diminished survival prognosis. Patients with stage IB LUAD containing cribriform components could derive survival benefit from postoperative ACT.