TY - JOUR
T1 - Main bronchus location is a predictor for metastasis and prognosis in lung adenocarcinoma
T2 - A large cohort analysis
AU - Yang, Lin
AU - Wang, Shidan
AU - Gerber, David E.
AU - Zhou, Yunyun
AU - Xu, Feng
AU - Liu, Jiewei
AU - Liang, Hao
AU - Xiao, Guanghua
AU - Zhou, Qinghua
AU - Gazdar, Adi
AU - Xie, Yang
N1 - Funding Information:
We thank the NCDB project for collecting this invaluable information and making it publically available. The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytical or statistical methodology employed, or the conclusions drawn from these data by the investigator. This work was supported by the National Institutes of Health [ 5R01CA152301 , P50CA70907 , 5P30CA142543 , 1R01GM115473 , K24CA201543 and 1R01CA172211 ], the Cancer Prevention and Research Institute of Texas [ RP120732 ], and the Fundamental Research Funds for the Central Universities, China ( 3332015060 ), the Key Project of International Cooperation of Science and Technology innovation between Governments , the National Key Research and Development Plan of China (No. 2016YEE0103400 ), and the National Natural Science Foundation of China (No. 81572288 )
Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/6
Y1 - 2018/6
N2 - Objectives: In the literature, inconsistent associations between the primary locations of lung adenocarcinomas (ADCs) with patient prognosis have been reported, due to varying definitions for central and peripheral locations. In this study, we investigated the clinical characteristics and prognoses of ADCs located in the main bronchus. Methods: A total of 397,189 lung ADCs registered from 2004 to 2013 in the National Cancer Database (NCDB) were extracted and divided into main bronchus-located ADCs (2.5%, N = 10,111) and non-main bronchus ADCs (97.5%, N = 387,078). The ADCs located in the main bronchus and those not in the main bronchus were compared in terms of patient prognosis, lymph node involvement, distant metastases and other clinical features, including rate of curative-intent resection, histologic grade, and stage. Results: ADCs located in the main bronchus had significantly worse patient survival than those in the non-main bronchus, both for all patients (HR = 1.82, 95% CI 1.78–1.86) and for those undergoing curative-intent resection (HR = 2.49, 95% CI 2.23–2.78). Furthermore, ADCs located in the main bronchus had a significantly higher rate of lymph node involvement and distant metastasis than those not in the main bronchus, when stratified by tumor size (trend test, p < e −16 ). Multivariate analysis of overall survival showed that main bronchus location is a prognostic factor (HR = 1.15, 95% CI 1.08–1.23) independent of other clinical factors. Conclusions: Main bronchus location is an independent predictor for metastasis and worse outcomes irrespective of stage and treatment. Tumor primary location might be considered in prognostication and treatment planning.
AB - Objectives: In the literature, inconsistent associations between the primary locations of lung adenocarcinomas (ADCs) with patient prognosis have been reported, due to varying definitions for central and peripheral locations. In this study, we investigated the clinical characteristics and prognoses of ADCs located in the main bronchus. Methods: A total of 397,189 lung ADCs registered from 2004 to 2013 in the National Cancer Database (NCDB) were extracted and divided into main bronchus-located ADCs (2.5%, N = 10,111) and non-main bronchus ADCs (97.5%, N = 387,078). The ADCs located in the main bronchus and those not in the main bronchus were compared in terms of patient prognosis, lymph node involvement, distant metastases and other clinical features, including rate of curative-intent resection, histologic grade, and stage. Results: ADCs located in the main bronchus had significantly worse patient survival than those in the non-main bronchus, both for all patients (HR = 1.82, 95% CI 1.78–1.86) and for those undergoing curative-intent resection (HR = 2.49, 95% CI 2.23–2.78). Furthermore, ADCs located in the main bronchus had a significantly higher rate of lymph node involvement and distant metastasis than those not in the main bronchus, when stratified by tumor size (trend test, p < e −16 ). Multivariate analysis of overall survival showed that main bronchus location is a prognostic factor (HR = 1.15, 95% CI 1.08–1.23) independent of other clinical factors. Conclusions: Main bronchus location is an independent predictor for metastasis and worse outcomes irrespective of stage and treatment. Tumor primary location might be considered in prognostication and treatment planning.
KW - Lung adenocarcinoma
KW - Main bronchus
KW - Patient prognosis
KW - Surgery
KW - The National Cancer Database
KW - Tumor location
UR - http://www.scopus.com/inward/record.url?scp=85044478516&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044478516&partnerID=8YFLogxK
U2 - 10.1016/j.lungcan.2018.03.011
DO - 10.1016/j.lungcan.2018.03.011
M3 - Article
C2 - 29748011
AN - SCOPUS:85044478516
SN - 0169-5002
VL - 120
SP - 22
EP - 26
JO - Lung Cancer
JF - Lung Cancer
ER -