title: Stage IA non-small cell lung cancer: vessel invasion is a poor prognostic factor and a new target of adjuvant chemotherapy.
abstract: This study reports the efficacy of adjuvant chemotherapy in stage IA non-small cell lung cancer (NSCLC) with vessel invasion (Vi). We sub-divided 322 patients with surgically resected pathological stage IA NSCLC into two groups according to Vi [non-Vi (n=237) and Vi (n=85)]. Both groups were compared with regard to age, gender, performance status, smoking habits, serum carcinoembryonic antigen level, extent of surgery, tumour size, histopathology, recurrence sites, and survival. The overall 5-year survival rates of non-Vi and Vi groups were 89.6% and 71.8% (P<0.001), respectively. Distant metastasis was observed more frequently in the Vi group (P<0.001, risk ratio: 9.06). Univariate and multivariable analyses identified poor performance status, squamous cell carcinoma, tumour size>or=15 mm and Vi as poor prognostic factors (P<0.05). The overall 5-year survival rate of stage IA Vi group nearly overlapped with that of patients with stage IB NSCLC. Retrospectively, oral uracil-tegafur chemotherapy increased the overall 5-year survival rate of stage IA Vi group by more than 25% (P=0.036). In conclusion, vessel invasion is a poor prognostic factor in patients with stage IA NSCLC. Prognosis of patients with Vi-stage IA NSCLC is similar to that of patients with stage IB NSCLC and is improved significantly by postoperative oral uracil-tegafur chemotherapy. Our preliminary study suggests that stage IA Vi group benefits from adjuvant chemotherapy.
authors.affiliation: Department of Chest Surgery, Oita Prefectural Hospital, 476 Bunyou, Oita-city, Oita 870-8511, and Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan. tomoshi@nagasaki-u.ac.jp
authors.forename: Tomoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Shinji
authors.initials: S
authors.lastname: Akamine
authors.forename: Masashi
authors.initials: M
authors.lastname: Muraoka
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Kamohara
authors.forename: Koichi
authors.initials: K
authors.lastname: Tsuji
authors.forename: Shogo
authors.initials: S
authors.lastname: Urabe
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Honda
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamasaki
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000517:prevention & control; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D005641:Tegafur / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014498:Uracil / Q000008:administration & dosage*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005641:Tegafur; D014498:Uracil