Pathology-based Risk Stratification Model For Patients With Resected Stage ? Invasive Adenocarcinoma

PART ? PREDICTORS OF RECURRENCE AND SURVIVAL OF PATHOLOGICAL T1N0M0 INVASIVE ADENOCARCINOMA FOLLOWING LOBECTOMYOBJECTIVE This retrospective research was designed to investigate the relationship between pT1N0M0 invasive adenocarcinoma(IADC)harboring solid(SOL)and/or micropapillary(MIP)components and its prognosis following lobectomy.METHODS Clinical data of pT1N0M0 IADC patients were retrospectively collected from Shanghai Chest Hospital.Survival curves were plotted by Kaplan-Meier methods.Multivariable cox regressions were conducted to discover the independent risk factors of recurrence-free survival(RFS)and overall survival(OS),through which nomograms were performed to visualize the risk of recurrences and outcomes in personalized information.RESULTS Totally 1965 patients were enrolled,including 248 harboring SOL/MIP and 1717 not.IADC demonstrated worse 5-year RFS(81.9% vs 92.2%,p<0.001)and OS(85.7% vs 94.4%,p<0.001)when harboring SOL and/or MIP components.And this status became an independent factor associated with poorer RFS(HR 2.445,95%CI 1.565-3.821,p<0.001)and OS(HR 2.139,95%CI 1.180-3.878,p=0.012)instead of novel classification of IADC predominant patterns.No difference existed between SOL/MIP predominant and minor patterns.In addition,age > 60,smoking,post-chemotherapy and T1 b were all indicating poorer RFS and smoking was also related with worse OS.The c-indexes of nomograms were 0.723 for RFS(95% CI,0.662 to 0.784)and 0.703 for OS(95% CI,0.629 to 0.777),respectively.CONCLUSIONS Once the pT1N0M0 IADC harboring SOL/MIP,it strongly indicated the worse clinical recurrence and survival outcome,no matter whether the SOL/MIP was predominant or not.Smoking was correlated with worse prognosis for those patients.Age>60 and stage T1 b also indicated poorer RFS.Whether post-chemotherapy was harmful to pT1N0M0 IADC patients needed further research.PART ? PATHOLOGY-BASED RISK STRATIFICATION MODEL FOR PATIENTS WITH PRSECTED STAGE I INVASIIVE ADENOCARCINOMABACKGROUND Tumor,Node,Metastasis(TNM)classification seemed less able to provide precisely prognostic prediction when T1-2a N0M0 occurred.Hence,we tried to establish a prognostic model based on a proposed new pathological classification and other clinical characteristics for resected stage ? adenocarcinoma(ADC).METHODS Clinicopathological data were retrospectively collected from Shanghai Chest Hospital and Fudan University Shanghai Cancer Center between January 2007 and December 2011.The proposed New Pathological Classification was defined according to certain subtype instead of predominant one.For instance,subtype harboring micropapillary component was classified as n MIP.Subtype containing solid component while not coexisting with micropapillary one was classified as n SOL.Cox regressions were analyzed for recurrence-free survival(RFS)and overall survival(OS)whereby risk models were established accordingly.The comparison between risk models and TNM classification was conducted through receiver operating characteristic curves(ROC),identified by the area under the curve(AUC).(?)RESULTS 3368 cases were retrospectively investigated and 1196 were included in the study.The multivariable analysis showed that n SOL and n MIP along with stage ?A3 and IB were independent recurrence predictors.Hence,personalized scores were calculated and risk stratifications were generated.Compared with TNM classification,our risk model demonstrated significant superiority in predicting early recurrence for invasive stage ? ADC patients with AUC comparison(1-year: 0.653 vs 0.556,p=0.033;3-year: 0.663 vs 0.607,p=0.008).CONCLUSION The risk stratification model based on our proposed pathological classification showed remarkable superiority over the 8th TNM classification when predicting early recurrence of resected stage ? ADC.