title: Surgically resected solitary cavitary lung adenocarcinoma: association between clinical, pathologic, and radiologic findings and prognosis.
abstract: BACKGROUND
  The incidence of cavitary lung adenocarcinoma has recently increased; despite this, little is known about its clinical features and prognosis. We, therefore, evaluated the clinicopathologic features and prognosis of this malignancy.
  
  
  METHODS
  Between 1998 and 2007, 2,316 patients without preoperative chemotherapy or radiation therapy underwent surgical resection for primary lung adenocarcinoma. Among these cases, 143 (6.2%) were diagnosed as having cavitary adenocarcinoma based on high-resolution computed tomography scans and were enrolled in our study.
  
  
  RESULTS
  Cavitary adenocarcinoma occurred more frequently in patients who were male (p < 0.001); who had a smoking history (p < 0.001), larger tumor size (p < 0.001), a tumor in the lower lobe (p < 0.001), lymph node metastasis (p = 0.02), advanced tumor stage (p = 0.04), postoperative recurrence (p < 0.01), and a papillary (p = 0.02) or solid predominant tumor pattern (p < 0.01); and who had vascular (p < 0.001), lymphatic (p = 0.04), or pleural invasion (p < 0.01). Kaplan-Meier analysis revealed that the overall and recurrence-free survival of patients with cavitary adenocarcinoma was significantly shorter than that of patients with noncavitary adenocarcinoma (p < 0.001). Multivariate analysis revealed that cavity formation was an independent prognostic factor in adenocarcinoma (p = 0.028).
  
  
  CONCLUSIONS
  Cavitary adenocarcinoma has worse prognostic clinicopathologic characteristics than noncavitary adenocarcinoma. Based on this finding, cavitary and noncavitary adenocarcinoma tumors should be considered separate entities.
authors.affiliation: Division of Pathology, National Cancer Center Hospital, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kusumoto
authors.affiliation: Division of Pathology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Department of Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Asamura
authors.affiliation: Division of Pathology, National Cancer Center Hospital, Tokyo, Japan. Electronic address: ktsuta@ncc.go.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuta
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D015996:Survival Rate; D055815:Young Adult