Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size

Abstract Introduction Tumor size is an absolute recurrence risk in lung cancer. Although morphological features also reflect recurrence risk, its significance among lower‐risk cases characterized by small size is unknown. We aimed to evaluate the relationship between pathological invasive tumor size...

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Autores principales:	Masaoki Ito, Yoshihiro Miyata, Kei Kushitani, Atsushi Kagimoto, Daisuke Ueda, Yasuhiro Tsutani, Yukio Takeshima, Morihito Okada
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	early stage IASLC lymphovascular invasion surgery TNM Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/661e0f51c8a84c069ea1cc18bd0b1629
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spelling	oai:doaj.org-article:661e0f51c8a84c069ea1cc18bd0b16292021-12-02T02:34:55ZPathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size1759-77141759-770610.1111/1759-7714.14163https://doaj.org/article/661e0f51c8a84c069ea1cc18bd0b16292021-12-01T00:00:00Zhttps://doi.org/10.1111/1759-7714.14163https://doaj.org/toc/1759-7706https://doaj.org/toc/1759-7714Abstract Introduction Tumor size is an absolute recurrence risk in lung cancer. Although morphological features also reflect recurrence risk, its significance among lower‐risk cases characterized by small size is unknown. We aimed to evaluate the relationship between pathological invasive tumor size and morphological features, and their prognostic impact by considering them simultaneously in lung adenocarcinoma. Patients and methods We retrospectively reviewed 563 pN0M0 patients with pathological invasive size of ≤40 mm. The patients were classified by pathological invasive size and pathological malignant grading using the proportion of subhistological components. The prognostic impact was evaluated using recurrence‐free survival (RFS) and overall survival (OS). The impact on prognosis was evaluated using uni‐ and multivariate analyses. Results The proportion of histological grade changed according to invasive tumor size. Patients with high malignant grade (G3) showed worse RFS than those with low and intermediate malignant grade (G1+2) with invasive size ≤20 mm. The 5‐year RFS (G1+2 vs. G3) in 5–10 mm was 96.0% vs. 83.3% (HR = 5.505, 95% CI = 7.156–1850, p < 0.001) and in 10–20 mm was 87.8% vs. 67.1% (HR = 2.829, 95% CI = 4.160–43.14, p < 0.001). G3 patients were significantly bigger in invasive size and included more pleural/lymphatic/vascular invasion and recurrence. Multivariate analysis indicated pathological G3 status was significantly associated with worse RFS (HR = 2.097, 95% CI = 1.320–3.333, p = 0.002). Conclusions Invasive tumor size and pathological malignant grade overlap in invasive adenocarcinoma. G3 patients are more likely to have pleural/lymphatic/vascular invasion and significantly worse RFS compared to G1/G2 cases, even with a small invasive size of ≤20 mm.Masaoki ItoYoshihiro MiyataKei KushitaniAtsushi KagimotoDaisuke UedaYasuhiro TsutaniYukio TakeshimaMorihito OkadaWileyarticleearly stageIASLClymphovascular invasionsurgeryTNMNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENThoracic Cancer, Vol 12, Iss 23, Pp 3141-3149 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	early stage IASLC lymphovascular invasion surgery TNM Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	early stage IASLC lymphovascular invasion surgery TNM Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Masaoki Ito Yoshihiro Miyata Kei Kushitani Atsushi Kagimoto Daisuke Ueda Yasuhiro Tsutani Yukio Takeshima Morihito Okada Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size
description	Abstract Introduction Tumor size is an absolute recurrence risk in lung cancer. Although morphological features also reflect recurrence risk, its significance among lower‐risk cases characterized by small size is unknown. We aimed to evaluate the relationship between pathological invasive tumor size and morphological features, and their prognostic impact by considering them simultaneously in lung adenocarcinoma. Patients and methods We retrospectively reviewed 563 pN0M0 patients with pathological invasive size of ≤40 mm. The patients were classified by pathological invasive size and pathological malignant grading using the proportion of subhistological components. The prognostic impact was evaluated using recurrence‐free survival (RFS) and overall survival (OS). The impact on prognosis was evaluated using uni‐ and multivariate analyses. Results The proportion of histological grade changed according to invasive tumor size. Patients with high malignant grade (G3) showed worse RFS than those with low and intermediate malignant grade (G1+2) with invasive size ≤20 mm. The 5‐year RFS (G1+2 vs. G3) in 5–10 mm was 96.0% vs. 83.3% (HR = 5.505, 95% CI = 7.156–1850, p < 0.001) and in 10–20 mm was 87.8% vs. 67.1% (HR = 2.829, 95% CI = 4.160–43.14, p < 0.001). G3 patients were significantly bigger in invasive size and included more pleural/lymphatic/vascular invasion and recurrence. Multivariate analysis indicated pathological G3 status was significantly associated with worse RFS (HR = 2.097, 95% CI = 1.320–3.333, p = 0.002). Conclusions Invasive tumor size and pathological malignant grade overlap in invasive adenocarcinoma. G3 patients are more likely to have pleural/lymphatic/vascular invasion and significantly worse RFS compared to G1/G2 cases, even with a small invasive size of ≤20 mm.
format	article
author	Masaoki Ito Yoshihiro Miyata Kei Kushitani Atsushi Kagimoto Daisuke Ueda Yasuhiro Tsutani Yukio Takeshima Morihito Okada
author_facet	Masaoki Ito Yoshihiro Miyata Kei Kushitani Atsushi Kagimoto Daisuke Ueda Yasuhiro Tsutani Yukio Takeshima Morihito Okada
author_sort	Masaoki Ito
title	Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size
title_short	Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size
title_full	Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size
title_fullStr	Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size
title_full_unstemmed	Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size
title_sort	pathological high malignant grade is higher risk of recurrence in pn0m0 invasive lung adenocarcinoma, even with small invasive size
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/661e0f51c8a84c069ea1cc18bd0b1629
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Pathological high malignant grade is higher risk of recurrence in pN0M0 invasive lung adenocarcinoma, even with small invasive size

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