Alessandro Bonis, Giulia Pagliarini, Giovanni Maria Comacchio, Marco Mammana, Federica Pezzuto, Vincenzo Verzeletti, Enrica Pellizzer, Alessandro Berni, Stefano Silvestrin, Giorgio Cannone, Eleonora Faccioli, Alessandro Rebusso, Marco Schiavon, Samuele Nicotra, Andrea Dell'Amore, Fiorella Calabrese, Federico Rea
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Clinical and pathological variables were assessed for their association with DR using univariable and multivariable logistic regression. An EGFR-adjusted model was also provided.</p><p><strong>Results: </strong>A total of 259 patients were treated (214 lobectomies and 45 segmentectomies). After resection, 54 patients relapsed, 28 of whom had distant recurrences (DR). Spread through air spaces (STAS) was detected in 48% of samples, while vascular invasion (VI) was present in 53%, occurring 17% more frequently in those with DR. Tumor size was larger in patients with recurrence, with the largest tumors observed in those with local recurrence (25.5 mm in local vs. 23.5 mm in DR; p=0.028). Dedifferentiated (G3) ADCs were more prevalent in DR cases, accounting for 48% of samples. In univariate regression, surgical margins, LVI, necrosis, G3 primary tumors, and STAS were significant factors. 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引用次数: 0
摘要
早期肺腺癌（ADC）在大多数情况下是可以通过手术切除治愈的。然而，出乎意料的是，一些患者经历了远处的疾病复发。越来越多的证据表明，显微肿瘤特征可能增加肿瘤复发的风险。因此，我们的目的是测试不同的微观变量来评估它们与远处复发（DR）的关系。材料和方法：我们检索了2016年至2020年所有经过根治的I-IIA期adc病例。使用单变量和多变量logistic回归评估临床和病理变量与DR的相关性。还提供了egfr调整模型。结果：共治疗259例患者，其中肺叶切除术214例，节段切除术45例。术后54例复发，其中28例远处复发（DR）。48%的样本检测到空气间隙扩散（STAS）， 53%的样本检测到血管浸润（VI），在DR患者中发生的频率高出17%。复发患者的肿瘤大小较大，局部复发患者的肿瘤最大（局部25.5 mm vs DR 23.5 mm; p=0.028）。去分化（G3） adc在DR病例中更为普遍，占样本的48%。在单因素回归中，手术边缘、LVI、坏死、G3原发肿瘤和STAS是显著因素。在多因素分析中，STAS呈显著性趋势（p=0.07），而G3仍具有决定性意义(p结论：去分化和部分STAS是切除的I-IIA期adc远处复发的关键病理预测因子。LVI和肿瘤坏死在DR中的作用有待进一步明确。肿瘤的侵袭性超越了简单的大小测量，要求重新评估手术后复发的风险模型。
Histologic grade and STAS as key predictors of distant recurrence in resected early-stage lung adenocarcinoma: a single-center study.
Introduction: Early-stage lung adenocarcinoma (ADC) is curable by surgical resection in most cases. However, unexpectedly, some patients experience distant disease relapse. Emerging evidence suggests that microscopic tumor characteristics may increase the risk of tumor relapse. Consequently, we aimed to test different microscopic variables to assess their association with distant recurrence (DR).
Materials and methods: We retrieved all cases of radically treated stage I-IIA ADCs from 2016 to 2020. Clinical and pathological variables were assessed for their association with DR using univariable and multivariable logistic regression. An EGFR-adjusted model was also provided.
Results: A total of 259 patients were treated (214 lobectomies and 45 segmentectomies). After resection, 54 patients relapsed, 28 of whom had distant recurrences (DR). Spread through air spaces (STAS) was detected in 48% of samples, while vascular invasion (VI) was present in 53%, occurring 17% more frequently in those with DR. Tumor size was larger in patients with recurrence, with the largest tumors observed in those with local recurrence (25.5 mm in local vs. 23.5 mm in DR; p=0.028). Dedifferentiated (G3) ADCs were more prevalent in DR cases, accounting for 48% of samples. In univariate regression, surgical margins, LVI, necrosis, G3 primary tumors, and STAS were significant factors. In multivariate analysis, STAS showed a trend towards significance (p=0.07) while G3 remained decisive (p<0.01). The EGFR-adjusted model for DR yielded slightly better results (p=0.05 and p<0.01 respectively).
Conclusions: Dedifferentiation and partially STAS are key pathological predictor of distant recurrence in resected stage I-IIA ADCs. The contribution of LVI and tumor necrosis in DR needs to be further clarified. Tumor aggressiveness goes beyond the simple size measurement, claiming for a reassessment of risk models for recurrence after surgery.
期刊介绍：
Cancer Imaging and Diagnosis is dedicated to the publication of results from clinical and research studies applied to cancer diagnosis and treatment. The section aims to publish studies from the entire field of cancer imaging: results from routine use of clinical imaging in both radiology and nuclear medicine, results from clinical trials, experimental molecular imaging in humans and small animals, research on new contrast agents in CT, MRI, ultrasound, publication of new technical applications and processing algorithms to improve the standardization of quantitative imaging and image guided interventions for the diagnosis and treatment of cancer.
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