Clinicopathological analysis of prognostic factors in clinical IA peripheral adenocarcinoma of the lung

Background The clinical IA (C-IA) lung cancer patient shows a 5-year survival rate of approximately 70% after surgical therapy alone. We have tried to clarify the prognostic factors in C-IA adenocarcinoma of the lung to identify those candidates who might benefit from preoperative or postoperative adjuvant therapy. Methods Between 1994 and June 2001, 54 patients were diagnosed with C-IA adenocarcinoma of the lung and underwent lobectomy and hilar and mediastinal node dissection. The clinicopathological records of the patients were examined for age, gender, nodal status, tumor size, serum CEA level, and histologic subtype (replacing vs nonreplacing type). Localized bronchioloalveolar carcinoma (LBAC; noninvasive cancer) was excluded from this study. Results Nodal involvement, high serum CEA level (≥ 4.0 ng/mL), and nonreplacing type were significant (p< 0.05) prognostic factors for poor outcome in univariate analyses. Nodal involvement, larger tumor size (≥ 20 mm), and nonreplacing type were significant (p< 0.05) prognostic factors for poor outcome in multivariate analyses. High serum CEA level and nonreplacing type were significant (p< 0.01) risk factors for lymph node involvement both in univariate and multivariate analyses. Up to 71.5% of patients with both factors showed lymph node metastases. Furthermore, based on histologic subtype and tumor size, the 4-year survival rate was 33% for patients with both of these factors, and 34.3% even if they were pN0. Conclusions C-IA patients, both with the larger tumor size (≥ 20 mm) and nonreplacing type, show poor outcome after surgery, and patients with both high serum CEA level and nonreplacing type are at high risk for lymph node metastases.