Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer

A pilot study

Francine R. Dembitzer, Raja M. Flores, Michael K. Parides, Mary Beth Beasley

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE: Th e 2011 International Association for the Study of Lung Cancer (IASLC)/American Th oracic Society (ATS)/European Respiratory Society (ERS) classifi cation of pulmonary adenocarcinomas introduces adenocarcinoma in situ and minimally invasive carcinoma and categorizes adenocarcinoma with more extensive invasion by the predominant subtype. Data have shown that wedge or segmentectomy (W/S) may be appropriate for in situ and minimally invasive adenocarcinoma, but whether sublobar resection is appropriate for tumors with more extensive invasion is unclear. Th e aim of this pilot study is to evaluate whether there are any trends regarding the impact of invasion and subtypes of carcinoma regarding survival in lobectomy vs W/S procedures using a comprehensive histologic evaluation. METHODS: Eighty-fi ve surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classifi ed by 2011 IASLC/ATS/ERS guidelines with each histologic pattern recorded as a percentage of the total tumor. Statistical analysis was performed using SAS, version 9.2. Proportional hazards regression analysis was used to evaluate survival according to resection type (lobectomy or W/S) adjusting for tumor size and the predominant histology. RESULTS: Multivariate analysis did not show a statistically signifi cant diff erence in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis ( P 5 .7704). C ONCLUSIONS: Our fi ndings corroborate the prognostic signifi cance of the 2011 adenocarcinoma subtyping classifi cation and additionally suggest that lobectomy does not off er an overall survival advantage over W/S regardless of histologic subtype. Th erefore, this fi nding suggests that lim ited resection may be appropriate for small size tumors, particularly those - 2 cm with invasive histology.

Original languageEnglish (US)
Pages (from-to)175-181
Number of pages7
JournalChest
Volume146
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Segmental Mastectomy
Lung Neoplasms
Adenocarcinoma
Neoplasms
Cations
Histology
Carcinoma
Necrosis
Multivariate Analysis
Regression Analysis
Guidelines

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer : A pilot study. / Dembitzer, Francine R.; Flores, Raja M.; Parides, Michael K.; Beasley, Mary Beth.

In: Chest, Vol. 146, No. 1, 01.01.2014, p. 175-181.

Research output: Contribution to journalArticle

Dembitzer, Francine R. ; Flores, Raja M. ; Parides, Michael K. ; Beasley, Mary Beth. / Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer : A pilot study. In: Chest. 2014 ; Vol. 146, No. 1. pp. 175-181.
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abstract = "OBJECTIVE: Th e 2011 International Association for the Study of Lung Cancer (IASLC)/American Th oracic Society (ATS)/European Respiratory Society (ERS) classifi cation of pulmonary adenocarcinomas introduces adenocarcinoma in situ and minimally invasive carcinoma and categorizes adenocarcinoma with more extensive invasion by the predominant subtype. Data have shown that wedge or segmentectomy (W/S) may be appropriate for in situ and minimally invasive adenocarcinoma, but whether sublobar resection is appropriate for tumors with more extensive invasion is unclear. Th e aim of this pilot study is to evaluate whether there are any trends regarding the impact of invasion and subtypes of carcinoma regarding survival in lobectomy vs W/S procedures using a comprehensive histologic evaluation. METHODS: Eighty-fi ve surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classifi ed by 2011 IASLC/ATS/ERS guidelines with each histologic pattern recorded as a percentage of the total tumor. Statistical analysis was performed using SAS, version 9.2. Proportional hazards regression analysis was used to evaluate survival according to resection type (lobectomy or W/S) adjusting for tumor size and the predominant histology. RESULTS: Multivariate analysis did not show a statistically signifi cant diff erence in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis ( P 5 .7704). C ONCLUSIONS: Our fi ndings corroborate the prognostic signifi cance of the 2011 adenocarcinoma subtyping classifi cation and additionally suggest that lobectomy does not off er an overall survival advantage over W/S regardless of histologic subtype. Th erefore, this fi nding suggests that lim ited resection may be appropriate for small size tumors, particularly those - 2 cm with invasive histology.",
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N2 - OBJECTIVE: Th e 2011 International Association for the Study of Lung Cancer (IASLC)/American Th oracic Society (ATS)/European Respiratory Society (ERS) classifi cation of pulmonary adenocarcinomas introduces adenocarcinoma in situ and minimally invasive carcinoma and categorizes adenocarcinoma with more extensive invasion by the predominant subtype. Data have shown that wedge or segmentectomy (W/S) may be appropriate for in situ and minimally invasive adenocarcinoma, but whether sublobar resection is appropriate for tumors with more extensive invasion is unclear. Th e aim of this pilot study is to evaluate whether there are any trends regarding the impact of invasion and subtypes of carcinoma regarding survival in lobectomy vs W/S procedures using a comprehensive histologic evaluation. METHODS: Eighty-fi ve surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classifi ed by 2011 IASLC/ATS/ERS guidelines with each histologic pattern recorded as a percentage of the total tumor. Statistical analysis was performed using SAS, version 9.2. Proportional hazards regression analysis was used to evaluate survival according to resection type (lobectomy or W/S) adjusting for tumor size and the predominant histology. RESULTS: Multivariate analysis did not show a statistically signifi cant diff erence in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis ( P 5 .7704). C ONCLUSIONS: Our fi ndings corroborate the prognostic signifi cance of the 2011 adenocarcinoma subtyping classifi cation and additionally suggest that lobectomy does not off er an overall survival advantage over W/S regardless of histologic subtype. Th erefore, this fi nding suggests that lim ited resection may be appropriate for small size tumors, particularly those - 2 cm with invasive histology.

AB - OBJECTIVE: Th e 2011 International Association for the Study of Lung Cancer (IASLC)/American Th oracic Society (ATS)/European Respiratory Society (ERS) classifi cation of pulmonary adenocarcinomas introduces adenocarcinoma in situ and minimally invasive carcinoma and categorizes adenocarcinoma with more extensive invasion by the predominant subtype. Data have shown that wedge or segmentectomy (W/S) may be appropriate for in situ and minimally invasive adenocarcinoma, but whether sublobar resection is appropriate for tumors with more extensive invasion is unclear. Th e aim of this pilot study is to evaluate whether there are any trends regarding the impact of invasion and subtypes of carcinoma regarding survival in lobectomy vs W/S procedures using a comprehensive histologic evaluation. METHODS: Eighty-fi ve surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classifi ed by 2011 IASLC/ATS/ERS guidelines with each histologic pattern recorded as a percentage of the total tumor. Statistical analysis was performed using SAS, version 9.2. Proportional hazards regression analysis was used to evaluate survival according to resection type (lobectomy or W/S) adjusting for tumor size and the predominant histology. RESULTS: Multivariate analysis did not show a statistically signifi cant diff erence in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis ( P 5 .7704). C ONCLUSIONS: Our fi ndings corroborate the prognostic signifi cance of the 2011 adenocarcinoma subtyping classifi cation and additionally suggest that lobectomy does not off er an overall survival advantage over W/S regardless of histologic subtype. Th erefore, this fi nding suggests that lim ited resection may be appropriate for small size tumors, particularly those - 2 cm with invasive histology.

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