Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs
ABSTRACT Introduction To identify high‐risk patients for recurrence in resected stage IA lung adenocarcinoma and evaluate the impact of adjuvant chemotherapy (ACT) on their prognosis, as well as explore potential novel adjuvant therapies. Methods Consecutive stage IA patients with ≥ 5% solid or micr...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-01-01
|
| Series: | Thoracic Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/1759-7714.15521 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832576751794913280 |
|---|---|
| author | Chen Shen Haoran Liu Bofei Li Jiaming Wang Yiyang Wang Feichao Bao Zhitao Gu Wentao Fang |
| author_facet | Chen Shen Haoran Liu Bofei Li Jiaming Wang Yiyang Wang Feichao Bao Zhitao Gu Wentao Fang |
| author_sort | Chen Shen |
| collection | DOAJ |
| description | ABSTRACT Introduction To identify high‐risk patients for recurrence in resected stage IA lung adenocarcinoma and evaluate the impact of adjuvant chemotherapy (ACT) on their prognosis, as well as explore potential novel adjuvant therapies. Methods Consecutive stage IA patients with ≥ 5% solid or micropapillary subtypes were analyzed. A nomogram was developed using Cox proportional hazards regression to predict recurrence‐free survival (RFS). In the high‐risk group after stratification, RFS was compared between patients receiving ACT and those under observation, as well as between patients with and without driver gene alterations. Results This real‐world study included 1328 patients, with a 5‐year RFS of 79.0%. T stage and predominant subtype were independent risk factors for RFS. Patients with T1c or solid/micropapillary‐predominant tumors were stratified into a high‐risk group (n = 483) using the nomogram. A significant difference in 5‐year RFS was observed between the high‐ and low‐risk groups (73.6% vs. 84.3%, p < 0.001). Among high‐risk patients, sixty‐seven (13.8%) received ACT; however, there was no improvement in 5‐year RFS compared to observation alone (69.1% vs. 75.0%, p = 0.655). Testing rates for EGFR mutation and ALK fusion among high‐risk patients were only 52.4% and 43.9%, respectively, while mutation rates reached up to 55.7% and 9.4%, respectively. These molecular alterations exhibited numerically worse 5‐year RFS compared to wild‐type (EGFR mutation, 70.6% vs. 87.8%, p = 0.108; ALK fusion, 66.3% vs. 73.6%, p = 0.404), though not significant. Conclusions ACT failed to meet the needs of stage IA patients with histological high‐risk features. Further exploration of effective adjuvant target therapies is warranted for this patient subgroup. |
| format | Article |
| id | doaj-art-429872257af94daa919873c1d72ffb1e |
| institution | Kabale University |
| issn | 1759-7706 1759-7714 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Thoracic Cancer |
| spelling | doaj-art-429872257af94daa919873c1d72ffb1e2025-01-30T22:40:34ZengWileyThoracic Cancer1759-77061759-77142025-01-01162n/an/a10.1111/1759-7714.15521Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet NeedsChen Shen0Haoran Liu1Bofei Li2Jiaming Wang3Yiyang Wang4Feichao Bao5Zhitao Gu6Wentao Fang7Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaDepartment of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine Shanghai Jiao Tong University Shanghai ChinaABSTRACT Introduction To identify high‐risk patients for recurrence in resected stage IA lung adenocarcinoma and evaluate the impact of adjuvant chemotherapy (ACT) on their prognosis, as well as explore potential novel adjuvant therapies. Methods Consecutive stage IA patients with ≥ 5% solid or micropapillary subtypes were analyzed. A nomogram was developed using Cox proportional hazards regression to predict recurrence‐free survival (RFS). In the high‐risk group after stratification, RFS was compared between patients receiving ACT and those under observation, as well as between patients with and without driver gene alterations. Results This real‐world study included 1328 patients, with a 5‐year RFS of 79.0%. T stage and predominant subtype were independent risk factors for RFS. Patients with T1c or solid/micropapillary‐predominant tumors were stratified into a high‐risk group (n = 483) using the nomogram. A significant difference in 5‐year RFS was observed between the high‐ and low‐risk groups (73.6% vs. 84.3%, p < 0.001). Among high‐risk patients, sixty‐seven (13.8%) received ACT; however, there was no improvement in 5‐year RFS compared to observation alone (69.1% vs. 75.0%, p = 0.655). Testing rates for EGFR mutation and ALK fusion among high‐risk patients were only 52.4% and 43.9%, respectively, while mutation rates reached up to 55.7% and 9.4%, respectively. These molecular alterations exhibited numerically worse 5‐year RFS compared to wild‐type (EGFR mutation, 70.6% vs. 87.8%, p = 0.108; ALK fusion, 66.3% vs. 73.6%, p = 0.404), though not significant. Conclusions ACT failed to meet the needs of stage IA patients with histological high‐risk features. Further exploration of effective adjuvant target therapies is warranted for this patient subgroup.https://doi.org/10.1111/1759-7714.15521adenocarcinoma of lungadjuvant chemotherapyanaplastic lymphoma kinaseepidermal growth factor receptornomogram |
| spellingShingle | Chen Shen Haoran Liu Bofei Li Jiaming Wang Yiyang Wang Feichao Bao Zhitao Gu Wentao Fang Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs Thoracic Cancer adenocarcinoma of lung adjuvant chemotherapy anaplastic lymphoma kinase epidermal growth factor receptor nomogram |
| title | Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs |
| title_full | Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs |
| title_fullStr | Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs |
| title_full_unstemmed | Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs |
| title_short | Risk Stratification and Adjuvant Chemotherapy for High‐Risk Stage IA Lung Adenocarcinoma: The Unmet Needs |
| title_sort | risk stratification and adjuvant chemotherapy for high risk stage ia lung adenocarcinoma the unmet needs |
| topic | adenocarcinoma of lung adjuvant chemotherapy anaplastic lymphoma kinase epidermal growth factor receptor nomogram |
| url | https://doi.org/10.1111/1759-7714.15521 |
| work_keys_str_mv | AT chenshen riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT haoranliu riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT bofeili riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT jiamingwang riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT yiyangwang riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT feichaobao riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT zhitaogu riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds AT wentaofang riskstratificationandadjuvantchemotherapyforhighriskstageialungadenocarcinomatheunmetneeds |