O-029 PATIENTS WITH MULTIFOCAL LUNG ADENOCARCINOMA WITH BAC FEATURES HAVE SIMILAR OUTCOMES AND SURVIVAL COMPARED WITH THOSE HAVING UNIFOCAL DISEASE

Publication Title

Interactive Cardiovascular & Thoracic Surgery

Document Type

Conference Proceeding

Publication Date

6-2014

Keywords

washington; swedish; swedish thoracic surgery

Abstract

  • Objectives: The term “BAC” includes newly defined adenocarcinoma-in situ (AIS), minimally invasive adenocarcinoma (MIA) or lepidic predominant adenocarcinoma (LPA). It presents as one or multiple lesions. In the IASLC classification, AIS and MIA are more indolent with a highly favourable prognosis, but TNM upstages multifocality to a worse prognosis. The differences in outcomes in patients with multifocal (MF) compared to unifocal (UF) disease are unclear. We hypothesized that outcomes are similar regardless of presentation.Methods: A retrospective chart review of patients with lung adenocarcinoma with “BAC” features.Results: A total of 143 patients were identified: MF in 81 (57%) and UF in 62 (43%). In addition to the dominant lesion, the MF group included 187 nodules: 45 were resected concomitantly (23 in the same lobe and 22 in an ipsilateral lobe) while 142 were radiologically surveyed. Lobectomy was performed mainly in the UF group (66% vs 44%; P < 0.01) while wedge resections in the MF group (41% vs 21%; P < 0.01). LPA was the most prevalent pathologic subtype and primarily in the UF group (71% vs 52%, P = 0.01). At 3.5 years of follow-up, local (3 vs 1), regional (16 vs 15) and distant recurrences (4 vs 3) were detected in the MF and UF group (P = 0.67). No new lesions occurred in the MF group; one in the UF. Only 1/142 surveyed pre-existing lesion required further treatment. No significant differences were observed in disease-free or overall survival at 5 years respectively (67.9% vs 68.5%, P = 0.38 and 90.9% vs 87.6%, P = 0.47).Conclusions: After resection of the dominant adenocarcinoma, patients with multifocal lesions behaved similarly to patients with unifocal disease. Recurrent disease, the development of new pulmonary lesions and survival were similar. This suggests that patients with multifocal disease should not be upstaged and should be treated with the same curative intent as those with unifocal disease.Disclosure: No significant relationships.
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Clinical Institute

Cancer

Specialty

Oncology

Specialty

Surgery

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