Patients with multiple nodules and a dominant lung adenocarcinoma have similar outcomes and survival compared with patients who have a solitary adenocarcinoma.
OBJECTIVE
Lepidic growth pattern lung adenocarcinoma commonly presents as a dominant lesion (DL) with associated pulmonary nodules either in the ipsilateral or contralateral lung fields, posing a challenge in clinical decision-making. These tumours may be clinically upstaged compared with those who present with solitary lesions and, as a result, may be offered different therapies. The purpose of this study is to compare recurrence rates, the development of new lesions and survival in patients with adenocarcinoma with a lepidic component presenting with a DL with or without additional nodules.


METHODS
We performed a 13-year retrospective chart review of patients with lepidic growth pattern adenocarcinoma. Patients were grouped into a uninodular group (UG) if they presented with a solitary lesion and a multinodular group (MG) if they had a DL with additional nodules. Clinicopathological features, outcomes and survival between the two groups were analysed.


RESULTS
A total of 149 patients were identified: 62 (42%) in the UG and 87 (58%) in the MG. In addition to the DL, 217 nodules were preoperatively identified in the MG: 60 were resected concomitantly with the DL, while 157 were radiologically surveyed. Invasive adenocarcinoma was the predominant pathological cell type in both groups. The median time of follow-up was 3 years [interquartile range (IQR) 1.9-5.1]. Local (1 vs 2%), regional (1 vs 3%) and distant recurrences (7 vs 4%) were detected, respectively, in the UG and the MG. In the UG, 20 new lesions were identified, while in the MG there were 28. Only 4 of 157 (2.5%) surveyed pre-existing lesions were found to be malignant and required further treatment. No statistically significant differences were observed in 5-year disease-free and overall survival between the UG and the MG (82.3 vs 83.8%, P = 0.254 and 86.7 vs 93.8%, P = 0.096, respectively).


CONCLUSIONS
We observed that patients with lepidic growth pattern adenocarcinoma presenting with a DL with associated secondary nodules appear to behave similarly to patients with a solitary lesion. Multiple nodules including those that are malignant in this specific subset of non-small-cell lung cancer should not be upstaged as advanced disease and patients should be treated with the same curative intent as those presenting with uninodular disease.
Center for Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Massimo
M
Castiglioni
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA brian.louie@swedish.org.
Brian E
BE
Louie
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Candice L
CL
Wilshire
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Alexander S
AS
Farivar
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Ralph W
RW
Aye
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Jed
J
Gorden
CellNetix Pathology and Laboratories, Seattle, WA, USA.
Matthew P
MP
Horton
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Eric
E
Vallières
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D003074:Solitary Pulmonary Nodule / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
Adenocarcinoma; Lung cancer surgery; Lung nodules; Multinodular; Outcomes; Uninodular