Identification of prognostic features for stage I lung cancer within surgical curative time window

P0172 

Abstract Submission 

Tong Li (1), Yang Zhang (2), Haiquan Chen (3)

(1) Fudan University Shanghai Cancer Center, Shanghai, Xinjiang, (2) Fudan University Shanghai Cancer Center, Shanghai, Shanghai, (3) Fudan University Shanghai Cancer Center, Shanghai, MA

Tong Li    -  Contact Me
Fudan University Shanghai Cancer Center

Yang Zhang    -  Contact Me
Fudan University Shanghai Cancer Center

*Haiquan Chen    -  Contact Me
Fudan University Shanghai Cancer Center

Tong Li    -  Contact Me
Fudan University Shanghai Cancer Center

Objective: To identify patient groups with favorable prognoses, especially within the surgical curative time window in stage I lung cancer, we investigated clinicopathologic features associated with recurrence after complete resection for stage I lung cancer.
Methods: We performed a retrospective analysis of patients with pathologic stage I lung cancer who underwent R0 resection between 2008 and 2015. Exclusion criteria included a history of lung cancer, induction or adjuvant therapy, and incomplete data. Uni- and multivariate Cox regression analyzed the association between clinicopathologic features and disease recurrence and identified protective factors.
Results: In total, 1503 patients met the inclusion criteria and 224 developed recurrence. The 5-year cumulative incidence of recurrence was 14.9%. Consolidation tumor ratio < 0.75, stage IA1, absence of lymphovascular invasion, lepidic-predominant adenocarcinoma, and solid component ≤ 10mm were independent protective factors. A systemic risk stratification method was thereby established. Patients with no less than 4 protective factors were classified into the low-risk group (n=223); those with 1-3 factors into the intermediate-risk group (n=1232), and the rest into the high-risk group (n=48). Kaplan-Meier curves showed statistically significant differences in recurrence-free survival (RFS) among the 3 groups (p < 0.001). The low-risk group, representing the curative time window population, achieved a 100% 5-year RFS, whereas 83.2% in the intermediate-risk group and 64.6% in the high-risk group. Subsequently, we further identified 3 additional protective factors from the intermediate-risk group: subsolid nodule, age ≤ 65, and stage ≤ IA2. Patients meeting all these criteria were classified into the relatively low-risk group, showing significant differences in 5-year RFS compared to the relatively high-risk group (94.0% vs 81.0%, p < 0.001).
Conclusion: Recurrence after resection for stage I lung cancer remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients with favorable prognoses and should be considered when assessing the prognosis of patients with stage I disease, thereby endeavoring the concept of the curative time window and enhancing treatment efficacy for this population.

Lung Cancer