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Recurrence Risk-Scoring Model for Stage I Adenocarcinoma of the Lung

 Hee Chul Yang  ;  Hyeong Ryul Kim  ;  Jae Yong Park  ;  Ju Sik Yun  ;  Kook Joo Na  ;  Young Mog Shim  ;  Jhingook Kim  ;  Jong Mog Lee  ;  Moon Soo Kim  ;  Jae Ill Zo  ;  Se Hoon Choi  ;  Dong Kwan Kim  ;  Seong Yong Park  ;  Mi Kyung Bae  ;  Kyung Young Chung  ;  Jin-Haeng Chung  ;  Ho-Young Lee  ;  Soyeon Ahn  ;  Sukki Cho  ;  Kwhanmien Kim  ;  Sanghoon Jheon 
 ANNALS OF SURGICAL ONCOLOGY, Vol.22(12) : 4089-4097, 2015 
Journal Title
Issue Date
Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/pathology* ; Adenocarcinoma/surgery ; Aged ; Blood Vessels/pathology ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology* ; Lung Neoplasms/surgery ; Lymphatic Vessels/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/epidemiology* ; Nomograms* ; Positron-Emission Tomography ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Tumor Burden
Locoregional Recurrence ; Validation Cohort ; Phantom Study ; Concordance Index ; Pathologic Tumor Size
PURPOSE: The aim of this retrospective, multicenter study was to develop a recurrence risk-scoring model in patients with curatively resected stage I lung adenocarcinoma (ADC). METHODS: Clinicopathologic and outcome data for a development cohort of 1,700 patients with pathologic stage I ADC from four institutions resected between January 2000 and December 2009 were evaluated. A phantom study was performed for correction of inter-institutional differences in positron emission tomography-standardized uptake value (PET-SUV). A nomogram for recurrence prediction was developed using Cox proportional hazards regression. This model was validated in a cohort of 460 patients in two other hospitals. The recurrence rate was 21.0 % for the development cohort and 22.1 % for the validation cohort. RESULTS: In multivariable analysis, three independent predictors for recurrence were identified: pathologic tumor size (hazard ratio [HR] 1.03, 95 % CI 1.017-1.048; p < 0.001), corrected PET-SUV (HR 1.08, 95 % CI 1.051-1.105; p < 0.001), and lymphovascular invasion (HR 1.65, 95 % CI 1.17-2.33; p = 0.004). The nomogram was made based on these factors and a calculated risk score was accorded to each patient. Kaplan-Meier analysis of the development cohort showed a 5-year recurrence-free survival (RFS) of 83 % (95 % CI 0.80-0.86) in low-risk patients and 59 % (95 % CI 0.54-0.66) in high-risk patients with the highest 30 percentile scores. The concordance index was 0.632 by external validation. CONCLUSIONS: This recurrence risk-scoring model can be used to predict the RFS for pathologic stage I ADC patients using the above three easily measurable factors. High-risk patients need close follow-up and can be candidates for adjuvant chemotherapy.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Chung, Kyung Young(정경영)
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