title: Predictive value of the international association for the study of lung cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma in tumor recurrence and patient survival.
abstract: OBJECTIVE
  This study investigated the pattern of recurrence of lung adenocarcinoma and the predictive value of histologic classification in resected lung adenocarcinoma using the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification system.
  
  
  METHODS
  Histologic classification of 573 patients undergoing resection for lung adenocarcinoma was determined according to the IASLC/ATS/ERS classification system, and the percentage of each histologic component (lepidic, acinar, papillary, micropapillary, and solid) was recorded. The pattern of recurrence of those components and their predictive value were investigated.
  
  
  RESULTS
  The predominant histologic pattern was significantly associated with sex (P < .01), invasive tumor size (P < .01), T status (P < .01), N status (P < .01), TNM stage (P < .01), and visceral pleural invasion (P < .01). The percentage of recurrence was significantly higher in micropapillary- and solid-predominant adenocarcinomas (P < .01). Micropapillary- and solid-predominant adenocarcinomas had a significantly higher possibility of developing initial extrathoracic-only recurrence than other types (P < .01). The predominant pattern group (micropapillary or solid v lepidic, acinar, or papillary) was a significant prognostic factor in overall survival (OS; P < .01), probability of freedom from recurrence (P < .01), and disease-specific survival (P < .01) in multivariable analysis. For patients receiving adjuvant chemotherapy, solid-predominant adenocarcinoma was a significant predictor for poor OS (P = .04).
  
  
  CONCLUSIONS
  In lung adenocarcinoma, the IASLC/ATS/ERS classification system has significant prognostic and predictive value regarding death and recurrence. Solid-predominant adenocarcinoma was also a significant predictor in patients undergoing adjuvant chemotherapy. Prognostic and predictive information is important for stratifying patients for aggressive adjuvant chemoradiotherapy.
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Jung-Jyh
authors.initials: JJ
authors.lastname: Hung
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Wen-Juei
authors.initials: WJ
authors.lastname: Jeng
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Kou-Juey
authors.initials: KJ
authors.lastname: Wu
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Biing-Shiun
authors.initials: BS
authors.lastname: Huang
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wu
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
authors.forename: Teh-Ying
authors.initials: TY
authors.lastname: Chou
authors.affiliation: All authors: National Yang-Ming University; Jung-Jyh Hung, Yi-Chen Yeh, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou, and Wen-Hu Hsu, Taipei Veterans General Hospital; Wen-Juei Jeng, Chang Gung University and Hospital; and Biing-Shiun Huang, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan. whhsu@vghtpe.gov.tw.
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Hsu
mesh_terms: D000230:Adenocarcinoma / Q000145:classification* / Q000401:mortality / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology