title: Recurrence Risk-Scoring Model for Stage I Adenocarcinoma of the Lung.
abstract: OBJECTIVE
  The aim of this retrospective, multicenter study was to develop a recurrence risk-scoring model in patients with curatively resected stage I lung adenocarcinoma (ADC).
  
  
  METHODS
  Clinicopathologic and outcome data for a development cohort of 1,700 patients with pathologic stage I ADC from four institutions resected between January 2000 and December 2009 were evaluated. A phantom study was performed for correction of inter-institutional differences in positron emission tomography-standardized uptake value (PET-SUV). A nomogram for recurrence prediction was developed using Cox proportional hazards regression. This model was validated in a cohort of 460 patients in two other hospitals. The recurrence rate was 21.0 % for the development cohort and 22.1 % for the validation cohort.
  
  
  RESULTS
  In multivariable analysis, three independent predictors for recurrence were identified: pathologic tumor size (hazard ratio [HR] 1.03, 95 % CI 1.017-1.048; p < 0.001), corrected PET-SUV (HR 1.08, 95 % CI 1.051-1.105; p < 0.001), and lymphovascular invasion (HR 1.65, 95 % CI 1.17-2.33; p = 0.004). The nomogram was made based on these factors and a calculated risk score was accorded to each patient. Kaplan-Meier analysis of the development cohort showed a 5-year recurrence-free survival (RFS) of 83 % (95 % CI 0.80-0.86) in low-risk patients and 59 % (95 % CI 0.54-0.66) in high-risk patients with the highest 30 percentile scores. The concordance index was 0.632 by external validation.
  
  
  CONCLUSIONS
  This recurrence risk-scoring model can be used to predict the RFS for pathologic stage I ADC patients using the above three easily measurable factors. High-risk patients need close follow-up and can be candidates for adjuvant chemotherapy.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Hyeong Ryul
authors.initials: HR
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea. jheon@snu.ac.kr.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Sukki
authors.initials: S
authors.lastname: Cho
authors.affiliation: Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jin-Haeng
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Seoul, South Korea.
authors.forename: Kyung Young
authors.initials: KY
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Seoul, South Korea.
authors.forename: Mi Kyung
authors.initials: MK
authors.lastname: Bae
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Seoul, South Korea.
authors.forename: Seong Yong
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Dong Kwan
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
authors.forename: Jong Mog
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.affiliation: Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, South Korea.
authors.forename: Kook Joo
authors.initials: KJ
authors.lastname: Na
authors.affiliation: Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, South Korea.
authors.forename: Ju Sik
authors.initials: JS
authors.lastname: Yun
authors.affiliation: Lung Cancer Center, Kyungpook National University Medical Center, Daegu, South Korea.
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Park
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D049451:Nomograms; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D047368:Tumor Burden