Brandt WS, et al. - Researchers here looked for factors associated with distant recurrence, disease-free survival (DFS), and overall survival (OS) following R0 lobectomy for pathologic node-negative (pN0) lung adenocarcinoma. In the study population, they recognized that pT (pathologic tumor) stage and lymphovascular invasion were associated with distant recurrence and decreased DFS.

Methods

• A retrospective analysis was performed of a prospectively maintained database of patients with pT1-3N0M0 non-small cell lung cancer.
• Researchers excluded patients with: metachronous lung cancer, sublobar/incomplete resection, non-adenocarcinoma histology, or induction/adjuvant therapy.
• Distant recurrence was assessed primarily.
• Secondarily they assessed DFS/OS.
• They assessed associations between variables and outcomes by using Fine and Gray competing risk regression for distant recurrence and Cox proportional hazard models for DFS/OS.

Results

• Researchers identified 2,392 patients with pT1-3N0M0 lung adenocarcinoma.
• Among these, 893 met the inclusion criteria.
• Median follow-up of 35.0 months (range, 0.1–202 months) was performed.
• Recurrence developed in 13% of patients (n=115); 86% (n=99) were distant.
• In this study, the 5-year cumulative incidence of distant recurrence was 14% (95% confidence interval [CI], 11%–17%).
• Multivariable analysis suggested that pT2a (HR, 2.84; 95% CI 1.56-5.16, P=0.001) and pT2b/3 (HR, 6.53; 95% CI, 3.17–13.5; P < 0.001) were correlated with distant recurrence.
• They observed decreased distant recurrence with recent surgery (HR 0.43, 95% CI 0.20-0.91, P=0.028).
• Lymphovascular invasion (LVI) had strong association with distant recurrence (HR, 1.62; 95% CI, 1.00–2.63; P=0.05).
• DFS had an independent association with pT stage (P < 0.001) and lymphovascular invasion (P=0.004).