Clinicopathology and prognosis of 489 patients with adenocarcinoma in situ and minimally invasive adenocarcinoma of lung_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yulin , CHEN Zhijun , YU Wei ,  ZHANG Yongkui

Department of Cardiothoracic Surgery, Zhoushan Hospital of Zhejiang Province, Zhoushan, 316021, Zhejiang, P.R.China;

Corresponding author：

ZHANG Yongkui, Email: zyk801801@126.com

Keywords：

Lung adenocarcinoma; adenocarcinoma in situ; minimally invasive adenocarcinoma; clinicopathology; prognosis

DOI：

10.7507/1007-4848.201607050

Video：

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Objective To investigate the clinical and pathological characteristics, prognosis and treatment strategies of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA). Methods We retrospectively analyzed the clinical data of 489 patients with AIS and MIA in our hospital from January 2007 to August 2015. There were 122 males and 367 females with an average age of 26–78 (51±9) years. According to the pathological types, they were divided into the AIS group (246 patients) and the MIA group (243 patients). In the AIS group, there were 60 males and 186 females with an average age of 50±7 years. In the MIA group, there were 62 males and 181 females with an average age of 54±5 years. The clinicopathological features, surgical methods and prognosis of the two groups were compared. Results There were significant differences in age, value of carcino-embryonic antigen (CEA), nodule shape and nodule size between the AIS and MIA groups (P<0.05). AIS patients were mostly under the age of 60 years with the value of CEA in the normal range which often appeared as pure ground-glass opacity lung nodules <1 cm in diameter on the CT scan. MIA often appeared as mixed ground-glass nodules <1.5 cm in diameter, accompanied by bronchiectasis and pleural indentation. The 5-year disease-free survival rate of the AIS and MIA groups reached 100%, and there was no statistical difference in the prognosis between the two groups after subtotal lobectomy (pulmonary resection and wedge resection) and lobectomy, systematic lymph node dissection and mediastinal lymph node sampling. Conclusion The analysis of preoperative clinical and imaging features can predict the AIS and MIA and provide individualized surgery and postoperative treatment program.

Citation： LI Yulin, CHEN Zhijun, YU Wei, ZHANG Yongkui. Clinicopathology and prognosis of 489 patients with adenocarcinoma in situ and minimally invasive adenocarcinoma of lung. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 445-449. doi: 10.7507/1007-4848.201607050 Copy

1.	Curado MP, Edwards B, Shin HR. Cancer incidence in five continents. Volume IX. France: IARC scientific publication, 2008. 1-837.
2.	Carter D, Vazquez M, Flieder DB, et al. Comparison of pathologic findings of baseline and annual repeat cancers diagnosed on CT screening. Lung Cancer, 2007, 56(2): 193-199.
3.	Matsuguma H, Mori K, Nakahara R, et al. Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning. Chest, 2013, 143(2): 436-443.
4.	Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest, 2013, 143(1): 172-178.
5.	Jiang B, Wang J, Jia P, et al. The value of CT attenuation in distinguishing atypical adenomatous hyperplasia from adenocarcinoma in situ. Zhongguo Fei Ai Za Zhi, 2013, 16(11): 579-583.
6.	Gu J, Lu C, Guo J, et al. Prognostic significance of the IASLC/ATS/ERS classification in Chinese patients-A single institution retrospective study of 292 lung adenocarcinoma. J Surg Oncol, 2013, 107(5): 474-80.
7.	Yoshizawa A, Sumiyoshi S, Sonobe M, et al. Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol, 2013, 8(1): 52-61.
8.	Woo T, Okudela K, Mitsui H, et al. Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases. Pathol Int, 2012, 62(12): 785-791.
9.	Ohta Y, Oda M, Wu J, et al. Can tumor size be a guidefor limited surgical intervention in patients with peripheral non-small cell lung cancer assessment from thepoint of view of nodal micrometastasis. J Thorac Cardiovasc Surg, 2001, 122(5): 900-906.
10.	Lee HY, Jeong JY, Lee KS, et al. Solitary pulmonary nodular lung adenocarcinoma: correlation of histopathologic scoring and patient survival with imaging biomarkers. Radiology, 2012, 264(3): 884-893.
11.	Lee SM, Park CM, Goo JM, et al. Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology, 2013, 268(1): 265-273.
12.	Takahashi M, Shigematsu Y, Ohta M, et al. Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters. J Thorac Cardiovasc Surg, 2014, 147(1): 54-59.
13.	Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
14.	高丰, 葛虓俊, 李铭, 等. 不同病理类型肺部磨玻璃结节的 CT 诊断. 中华肿瘤杂志, 2014, 36(3): 188-192.
15.	Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1N0M0 small-sized lung cancer. J Thorac Cardiovasc Surg, 2003, 125(4): 924-928.
16.	Okada M, Sakalnoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinic-surgical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2006, 81: 1028-1032.
17.	Tsutani Y, Miyata Y, Nakayama H, et al. Prediction of pathologic node-negative clinical Stage ⅠA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thorac Cardiovasc Surg, 2012, 144(6): 1365-1371.
18.	Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg, 2012, 94(2): 668-681.

1. Curado MP, Edwards B, Shin HR. Cancer incidence in five continents. Volume IX. France: IARC scientific publication, 2008. 1-837.
2. Carter D, Vazquez M, Flieder DB, et al. Comparison of pathologic findings of baseline and annual repeat cancers diagnosed on CT screening. Lung Cancer, 2007, 56(2): 193-199.
3. Matsuguma H, Mori K, Nakahara R, et al. Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning. Chest, 2013, 143(2): 436-443.
4. Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest, 2013, 143(1): 172-178.
5. Jiang B, Wang J, Jia P, et al. The value of CT attenuation in distinguishing atypical adenomatous hyperplasia from adenocarcinoma in situ. Zhongguo Fei Ai Za Zhi, 2013, 16(11): 579-583.
6. Gu J, Lu C, Guo J, et al. Prognostic significance of the IASLC/ATS/ERS classification in Chinese patients-A single institution retrospective study of 292 lung adenocarcinoma. J Surg Oncol, 2013, 107(5): 474-80.
7. Yoshizawa A, Sumiyoshi S, Sonobe M, et al. Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol, 2013, 8(1): 52-61.
8. Woo T, Okudela K, Mitsui H, et al. Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases. Pathol Int, 2012, 62(12): 785-791.
9. Ohta Y, Oda M, Wu J, et al. Can tumor size be a guidefor limited surgical intervention in patients with peripheral non-small cell lung cancer assessment from thepoint of view of nodal micrometastasis. J Thorac Cardiovasc Surg, 2001, 122(5): 900-906.
10. Lee HY, Jeong JY, Lee KS, et al. Solitary pulmonary nodular lung adenocarcinoma: correlation of histopathologic scoring and patient survival with imaging biomarkers. Radiology, 2012, 264(3): 884-893.
11. Lee SM, Park CM, Goo JM, et al. Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology, 2013, 268(1): 265-273.
12. Takahashi M, Shigematsu Y, Ohta M, et al. Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters. J Thorac Cardiovasc Surg, 2014, 147(1): 54-59.
13. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
14. 高丰, 葛虓俊, 李铭, 等. 不同病理类型肺部磨玻璃结节的 CT 诊断. 中华肿瘤杂志, 2014, 36(3): 188-192.
15. Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1N0M0 small-sized lung cancer. J Thorac Cardiovasc Surg, 2003, 125(4): 924-928.
16. Okada M, Sakalnoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinic-surgical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2006, 81: 1028-1032.
17. Tsutani Y, Miyata Y, Nakayama H, et al. Prediction of pathologic node-negative clinical Stage ⅠA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thorac Cardiovasc Surg, 2012, 144(6): 1365-1371.
18. Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg, 2012, 94(2): 668-681.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinicopathology and prognosis of 489 patients with adenocarcinoma in situ and minimally invasive adenocarcinoma of lung

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