09 Aug Lung Cancer: Micropapillary Morphology To Guide Resection vs Lobectomy Choice

MedicalResearch.com Interview with: Prasad Adusumilli MD, FACS
Associate Member, Thoracic Surgery
Memorial Sloan-Kettering Cancer Center
New York

MedicalResearch.com: What are the main findings of the study?

Answer: The current standard of care of for early-stage lung adenocarcinoma, the common form of lung cancer is curative-intent surgery either by limited resection, LR (removal of tumor with clear margins) or lobectomy, LO (removal of one-third to one-half of the lung harboring the tumor). Although lung-sparing LR is preferable, there is a reported incidence of 30-40% of recurrences within the same lung. The causative factor/s for these local recurrences is not known.

In our study, we analyzed recurrence patterns and pathological features in patients who underwent 476 LO and 258 LR performed at the Memorial Sloan-Kettering Cancer Center, New York. We investigated the morphological patterns in pathology specimens utilizing the recently proposed International Association for the Study of Lung Cancer / European Respiratory Society / American Thoracic Society (IASLC/ERS/ATS) classification. We noticed that presence of micropapillary morphology was associated with three times higher recurrences in patients undergoing LR compared to LO, these recurrences were lower when there is an adequate margin (2 cm) resected beyond the tumor. In patients undergoing LO, the recurrences were 75% less.

MedicalResearch.com Were any of the findings unexpected?

Answer: Although higher recurrence pattern following limited resection for early-stage lung cancers is known, the underlying factor is not known. Our study for the first time identifies the causative factor for higher local recurrences. Our extensive analysis of all morphological patterns clearly identified micropapillary morphology alone as a contributing factor which is unexpected.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: More than 250,000 patients are diagnosed with non-small lung cancer in the US alone, one third of them diagnosed at an early-stage. Surgical resection is curative-intent for these patients. Our report identifies the factor that can help strategize patients for appropriate surgical resection; thereby reducing the recurrence rates by 75%.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: Although presence of micropapillary morphology predicts local recurrences, currently there are no tools/methods to identify presence of this morphology pre-operatively. Tests to identify the micropapillary morphology pre-operatively will help stratify patients for appropriate surgical resection or alternative additional therapies in cases where lobectomy cannot be performed. Investigating the underlying mechanisms for the local spread of micropapillary morphology will help discover newer therapeutic strategies.

Citation:

Impact of Micropapillary Histologic Subtype in Selecting Limited Resection vs Lobectomy for Lung Adenocarcinoma of 2cm or Smaller

Jun-ichi Nitadori, Adam J. Bograd, Kyuichi Kadota, Camelia S. Sima, Nabil P. Rizk, Eduardo A. Morales, Valerie W. Rusch, William D. Travis, and Prasad S. Adusumilli

Impact of Micropapillary Histologic Subtype in Selecting Limited Resection vs Lobectomy for Lung Adenocarcinoma of 2cm or Smaller
JNCI J Natl Cancer Inst first published online August 7, 2013 doi:10.1093/jnci/djt166

Last Updated on September 14, 2014 by Marie Benz MD FAAD