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Original Research: Lung Cancer |

Impact of Histologic Subtyping on Outcome in Lobar vs Sublobar Resections for Lung CancerImpact of Histology on Lung Cancer Resection Type: A Pilot Study

Francine R. Dembitzer, MD; Raja M. Flores, MD, FCCP; Michael K. Parides, PhD; Mary Beth Beasley, MD
Author and Funding Information

From the Department of Pathology (Drs Dembitzer and Beasley), Department of Cardiothoracic Surgery (Dr Flores), and Mount Sinai Center for Biostatistics (Dr Parides), Icahn School of Medicine at Mount Sinai, New York, NY.

CORRESPONDENCE TO: Francine R. Dembitzer, MD, Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029; e-mail: Francine.Dembitzer@mountsinai.org


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):175-181. doi:10.1378/chest.13-2506
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OBJECTIVE:  The 2011 International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification 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. The 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-five surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classified 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 significant difference in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis (P = .7704).

CONCLUSIONS:  Our findings corroborate the prognostic significance of the 2011 adenocarcinoma subtyping classification and additionally suggest that lobectomy does not offer an overall survival advantage over W/S regardless of histologic subtype. Therefore, this finding suggests that limited resection may be appropriate for small size tumors, particularly those ≤ 2 cm with invasive histology.

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