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  • In multivariate analysis both the cribriform component HR

    2019-08-26

    In multivariate analysis, both the cribriform component (HR of RFS, 2.82, 95% CI, 1.68–4.74, p < 0.001; HR of OS, 2.73, 95% CI, 1.74–4.29, p < 0.001) and STAS (HR of RFS, 5.19, 95% CI, 3.10–8.69, p < 0.001; HR of OS, 4.27, 95% CI, 2.78–6.54, p < 0.001) were independent risk factors of inferior RFS and OS. Although some researchers once considered that ABT-888 (Veliparib) the poor prognostic association with STAS is due to other clinicopathological factors, our study found that STAS remained an independent prognostic predictor for worse outcomes, which was consistent with others [[17], [18], [19],22,25]. Further logistic regression analyses identified that the cribriform component (OR, 2.21, 95% CI, 1.02–4.77, p = 0.044) was an independent risk factor for increased frequency of STAS. In view of this, we considered that the occurrence of STAS probably affected survival in adenocarcinoma patients with a cribriform component. Among patients with a cribriform component, the survival analyses indicated that Crib+/STAS + patients had significantly inferior outcomes when compared with Crib+ /STAS- patients (RFS: 5-year rate, 4% vs. 32%, p < 0.001; OS: 5-year rate, 2% vs. 21%, p < 0.001), demonstrating the additional prognostic value provided by STAS for patients with a cribriform component. A multivariate Cox regression analysis further confirmed that STAS was an independent risk factor of inferior RFS (HR, 3.17, 95% CI, 1.61–6.26, p = 0.001) and OS (HR, 3.64, 95% CI, 1.90–6.96, p < 0.001) in patients with a cribriform component. Taken together, we consider that the existence of a cribriform component and a STAS-positive status should be regarded as synergistic prognostic factors in LUAD. Therefore, STAS may be one of the potential mechanisms by which the cribriform component leads to poor survival in postoperative patients.
    Conclusions
    Funding This work was supported by Jiangsu Provincial Commission of Health and Family Planning (grant numbers H201521); the Natural Science Foundation of Jiangsu Province (grant numbers BK20161224); Suzhou Key Discipline for Medicine (grant numbers SZXK201803); the Science and Technology Research Foundation of Suzhou Municipality (grant numbers SYS2018063, SYS2018064); National foundation of science and technology (grant numbers 81802989) and Hospital internal research foundation for PhD (grant numbers SDFEYBS1709).
    Acknowledgement
    Introduction Non-small cell lung cancer (NSCLC) staging determines both treatment and prognosis. Anatomic resection (with lymphadenectomy) is indicated in patients with early-stage NSCLC (ter surgery (pN+) occurs in about 20% of patients [3]. This is a surgical quality marker since under diagnosis of nodal involvement leads to under adjuvant therapy and, therefore, may have significant prognostic implications. Video-Assisted Thoracic Surgery (VATS) lobectomy is currently recommended over open surgery (THO) for the treatment of patients with < IIB NSCLC because long-term survival is similar but post-operative pain and hospital stay are reduced [4]. However, the ability of VATS to adequately perform lymphadenectomy has been questioned. In fact, some recent studies reported that, in patients with < IIB NSCLC, the incidence of nodal (pN1) upstaging after VATS was lower than after THO [5,6]. Others suggested that atom may be related to tumor centrality and not to the specific surgical procedure used [7]. To address these questions, we investigated: (1) the prevalence of pN+, pN1 and pN2 (mediastinal) in patients with < IIB NSCLC treated with VATS or THO in our center; (2) potential risk factors for nodal upstaging; and (3) survival after VATS and THO in patients with (pN+, pN1, pN2) or without (pN0) nodal upstaging.