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A specific pattern found in the tumor pathology of some patients with lung cancer is a strong predictor of recurrence after surgery, a factor that could be important in guiding treatment, say researchers at Memorial Sloan-Kettering Cancer Center in New York City.[1] To the best of their knowledge, the study offers the first scientific evidence indicating which patients are more likely to benefit from less radical lung-sparing surgery and which will benefit from more extensive surgery. Making this distinction could potentially reduce the risk of lung cancer recurrence by 75%, the authors say.

Researchers retrospectively evaluated the clinical characteristics and pathology information of 734 patients who underwent surgery for early-stage adenocarcinoma, the most common subtype of non-small cell lung cancer. They found that tumors in 40% of those patients exhibited an abnormal cell pattern that was strongly associated with disease recurrence after surgery.

Currently, there are no evidence-based criteria for choosing the most effective surgical approach for patients with small early-stage lung adenocarcinomas. The study suggests that limited surgical resection may not be best for patients with this classification, called micropapillary (MIP) morphology. This group was found to have a 34% risk of the cancer returning 5 years after lungsparing surgery, in which the tumor is removed by minimally invasive means and lung function is preserved.

The same group of patients who underwent lobectomy only had a 12% recurrence rate over a 5-year period. If the surgeon performs lung-sparing surgery in the presence of the MIP pattern, the chance of recurrence is high in the spared lobe. A lobectomy can reduce the risk of disease recurrence by 75%. If the MIP pattern is not found, the surgeon can perform the lung-sparing surgery without as great a risk of recurrence.

The researchers at Memorial Sloan-Kettering Cancer Center are working to develop new technology that can identify the MIP pattern before or during surgery. That knowledge would not only help physicians to determine treatment but also would reduce the need for additional surgeries, they say.

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  • 1
    Nitadori J , Bograd AJ , Kadota K , et al. Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2cm or smaller. J Natl Cancer Inst. 2013;105:1212-1220.