Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy

• Published in: Annals of surgical oncology 2019-08, Vol.26 (8), p.2392-2400
• Main Authors: Qian, Jie, Xu, Jianlin, Wang, Shuyuan, Qian, Fangfei, Yang, Wenjia, Zhang, Bo, Zhang, Yanwei, Nie, Wei, Lou, Yuqing, Lu, Jun, Zhang, Xueyan, Zhang, Wei, Chu, Tianqing, Zhong, Hua, Fang, Wentao, Zhao, Heng, Han, Baohui
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma of Lung - drug therapy; Adenocarcinoma of Lung - pathology; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Chemotherapy, Adjuvant - mortality; China - epidemiology; Female; Follow-Up Studies; Humans; Incidence; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - mortality; Nomograms; Oncology; Pneumonectomy; Prognosis; Retrospective Studies; Risk Factors; Risk groups; Surgery; Surgical Oncology; Survival Rate; Thoracic Oncology; Tumor Burden
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-019-07366-z

Background This study aimed to explore adjuvant chemotherapy (ACT) candidates based on a recurrence risk-scoring model in completely lobectomized stage I patients with lung adenocarcinoma (LAD). Methods A retrospective study was performed on 4606 patients (non-ACT group: n  = 3514; ACT group: n  = 1092) who underwent complete lobectomy for LAD at Shanghai Chest Hospital from 2008 to 2014. The nomogram predicting recurrence-free survival (RFS) was developed in the non-ACT group using Cox proportional hazards regression. The nomogram-based risk score was calculated in the entire cohort. Differences of RFS between the non-ACT and ACT groups were compared as stratified by the risk score. The score cut-off points were determined using the X-tile software. Results Six independent predictors, including age, sex, tumor size, pathological subtype, visceral pleural invasion (VPI), and lymphovascular invasion (LVI) were associated with RFS. The nomogram more accurately predicted RFS than the 8th TNM staging {C-index: 0.784 [95% confidence interval (CI) 0.756–0.812] vs. 0.719 (95% CI 0.689–0.749), p  = 0.0017}. A significant RFS difference was observed among the low-, intermediate- and high-risk groups ( p