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Preference of grade and lymphovascular invasion over invasive size measurement in stage I lung adenocarcinoma
  1. Hiroe Itami1,
  2. Takeshi Kawaguchi2,
  3. Daiki Yoshikawa2,
  4. Takashi Watanabe3,
  5. Chiyoko Terada1,
  6. Fumi Okada1,
  7. Tomoko Uchiyama1,
  8. Maiko Takeda1,
  9. Eiwa Ishida4,
  10. Yuko Nishimoto5,
  11. Hiroshi Okada5,
  12. Keiji Kushibe3,
  13. Noriyoshi Sawabata2,
  14. Chiho Ohbayashi1
  1. 1Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
  2. 2Department of Thoracic and Cardio-Vascular Surgery, Nara Medical University, Kashihara, Nara, Japan
  3. 3Department of General Thoracic Surgery, Nara Prefecture General Medical Center, Nara, Japan
  4. 4Department of Diagnostic Pathology, Nara Prefecture General Medical Center, Nara, Japan
  5. 5Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Nara, Japan
  1. Correspondence to Dr Hiroe Itami, Department of Diagnostic Pathology, Nara Medical University, Kashihara 634-8521, Japan; hritami1237{at}


Aims Although it is necessary to measure the invasive size of lung adenocarcinoma with a lepidic component, it is not uncommon to have trouble in measuring the invasive size of lung adenocarcinoma. This study examined whether there were other stronger prognostic factors than invasive size.

Methods We characterised the clinicopathological features associated with recurrence-free survival (RFS) of 686 patients with the pathological stage (p-Stage) I lung adenocarcinoma. Moreover, we compared the area under the curve (AUC) values for recurrence between various combinations of pathological-baseline (age & sex & p-Stage based on invasive size) (B(i)) and several prognostic factors, and various combinations of p-baseline based on total tumour size (B(t)) and several prognostic factors.

Results AUC showed no significant differences between B(i) & new International Association for the Study of Lung Cancer grade (G) or vascular invasion (V), and B(t) & G or V. AUC was the highest in B & G & lymphatic invasion (L) & V. RFS was significantly shorter in patients with G3 OR L(+) OR V(+) than in those with G≤2 AND L(-) AND V(-) in each p-Stage based on invasive size (p-Stage(i)) and p-Stage based on total tumour size (p-Stage(t)) (p<0.05), and there were no significant differences in RFS between each p-Stage(i) and p-Stage(t).

Conclusions In any invasive size or total tumour size of p-Stage I lung adenocarcinoma, G, L and V are more powerful prognostic factors than the size criteria of p-Stage. Therefore, pathologists should focus on these pathological findings.

  • lung
  • carcinoma
  • pathology
  • surgical

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Handling editor Runjan Chetty.

  • Contributors HI and CO conceived and planned the study. TK, DY, TW, YN, HO, KK and NS provided the clinical data. HI, CO, CT, FO, TU, MT and EI carried out the pathological diagnosis of lung adenocarcinoma. HI performed the statistical analysis. HI and CO contributed to the interpretation of the results. HI wrote the manuscript with the support of CO. CO gave the final approval of the manuscript. All the authors critically reviewed and approved the manuscript. HI is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.