Abstract：
OBJECTIVE: There is a lack of knowledge regarding the use of prognostic features in stage I lung adenocarcinoma (LUAD). Thus, we investigated clinicopathologic features associated with recurrence after complete resection for stage I LUAD.
METHODS: We performed a retrospective analysis of patients with pathologic stage I LUAD who underwent R0 resection from 2010 to 2020. Exclusion criteria included history of lung cancer, induction or adjuvant therapy, noninvasive or mucinous LUAD, and death within 90 days of surgery. Fine and Gray competing-risk regression assessed associations between clinicopathologic features and disease recurrence.
RESULTS: In total, 1912 patients met inclusion criteria. Most patients (1565 [82%]) had stage IA LUAD, and 250 developed recurrence: 141 (56%) distant and 109 (44%) locoregional only. The 5-year cumulative incidence of recurrence was 12% (95% CI, 11%-14%). Higher maximum standardized uptake value of the primary tumor (hazard ratio [HR], 1.04), sublobar resection (HR, 2.04), higher International Association for the Study of Lung Cancer grade (HR, 5.32 [grade 2]; HR, 7.93 [grade 3]), lymphovascular invasion (HR, 1.70), visceral pleural invasion (HR, 1.54), and tumor size (HR, 1.30) were independently associated with a hazard of recurrence. Tumors with 3 to 4 high-risk features had a higher cumulative incidence of recurrence at 5 years than tumors without these features (30% vs 4%; P < .001).
CONCLUSIONS: Recurrence after resection for stage I LUAD remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients at high risk of recurrence and should be considered when assessing the prognosis of patients with stage I disease.
METHODS: We performed a retrospective analysis of patients with pathologic stage I LUAD who underwent R0 resection from 2010 to 2020. Exclusion criteria included history of lung cancer, induction or adjuvant therapy, noninvasive or mucinous LUAD, and death within 90 days of surgery. Fine and Gray competing-risk regression assessed associations between clinicopathologic features and disease recurrence.
RESULTS: In total, 1912 patients met inclusion criteria. Most patients (1565 [82%]) had stage IA LUAD, and 250 developed recurrence: 141 (56%) distant and 109 (44%) locoregional only. The 5-year cumulative incidence of recurrence was 12% (95% CI, 11%-14%). Higher maximum standardized uptake value of the primary tumor (hazard ratio [HR], 1.04), sublobar resection (HR, 2.04), higher International Association for the Study of Lung Cancer grade (HR, 5.32 [grade 2]; HR, 7.93 [grade 3]), lymphovascular invasion (HR, 1.70), visceral pleural invasion (HR, 1.54), and tumor size (HR, 1.30) were independently associated with a hazard of recurrence. Tumors with 3 to 4 high-risk features had a higher cumulative incidence of recurrence at 5 years than tumors without these features (30% vs 4%; P < .001).
CONCLUSIONS: Recurrence after resection for stage I LUAD remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients at high risk of recurrence and should be considered when assessing the prognosis of patients with stage I disease.
摘要：
目的：关于在I期肺腺癌（LUAD）中使用预后特征的知识缺乏。因此，我们调查了与I期LUAD完全切除后复发相关的临床病理特征.
方法：我们对2010年至2020年接受R0切除的I期LUAD患者进行了回顾性分析。排除标准包括肺癌病史，诱导或辅助治疗，非侵入性或粘液性LUAD，手术后90天内死亡。精细和灰色竞争风险回归评估临床病理特征和疾病复发之间的关联。
结果：总计，1912名患者符合纳入标准。大多数患者（1565[82%]）患有IALUAD期，250例发生复发：仅远处141例（56％）和局部109例（44％）。5年累积复发率为12%(95%置信区间,11%-14%）。原发性肿瘤的最大标准化摄取值较高（危险比[HR]=1.04），叶下切除术（HR=2.04），较高的IASLC等级（HR=5.32[等级2]；HR=7.93[等级3]），淋巴管浸润（HR=1.70），内脏胸膜侵犯（HR=1.54），肿瘤大小（HR=1.30）与复发风险独立相关。具有3-4个高危特征的肿瘤在5年时的累积复发率高于没有这些特征的肿瘤（30％vs.4%；p<0.001)。
结论：I期LUAD切除后复发仍是部分患者的问题。通常报告的临床病理特征可用于定义具有高复发风险的患者，并且在评估I期疾病患者的预后时应予以考虑。
方法：我们对2010年至2020年接受R0切除的I期LUAD患者进行了回顾性分析。排除标准包括肺癌病史，诱导或辅助治疗，非侵入性或粘液性LUAD，手术后90天内死亡。精细和灰色竞争风险回归评估临床病理特征和疾病复发之间的关联。
结果：总计，1912名患者符合纳入标准。大多数患者（1565[82%]）患有IALUAD期，250例发生复发：仅远处141例（56％）和局部109例（44％）。5年累积复发率为12%(95%置信区间,11%-14%）。原发性肿瘤的最大标准化摄取值较高（危险比[HR]=1.04），叶下切除术（HR=2.04），较高的IASLC等级（HR=5.32[等级2]；HR=7.93[等级3]），淋巴管浸润（HR=1.70），内脏胸膜侵犯（HR=1.54），肿瘤大小（HR=1.30）与复发风险独立相关。具有3-4个高危特征的肿瘤在5年时的累积复发率高于没有这些特征的肿瘤（30％vs.4%；p<0.001)。
结论：I期LUAD切除后复发仍是部分患者的问题。通常报告的临床病理特征可用于定义具有高复发风险的患者，并且在评估I期疾病患者的预后时应予以考虑。
