Surgically resected solitary cavitary lung adenocarcinoma: association between clinical, pathologic, and radiologic findings and prognosis.

Abstract

The incidence of cavitary lung adenocarcinoma has recently increased; despite this, little is known about its clinical features and prognosis. We, therefore, evaluated the clinicopathologic features and prognosis of this malignancy. Between 1998 and 2007, 2,316 patients without preoperative chemotherapy or radiation therapy underwent surgical resection for primary lung adenocarcinoma. Among these cases, 143 (6.2%) were diagnosed as having cavitary adenocarcinoma based on high-resolution computed tomography scans and were enrolled in our study. Cavitary adenocarcinoma occurred more frequently in patients who were male (p < 0.001); who had a smoking history (p < 0.001), larger tumor size (p < 0.001), a tumor in the lower lobe (p < 0.001), lymph node metastasis (p = 0.02), advanced tumor stage (p = 0.04), postoperative recurrence (p < 0.01), and a papillary (p = 0.02) or solid predominant tumor pattern (p < 0.01); and who had vascular (p < 0.001), lymphatic (p = 0.04), or pleural invasion (p < 0.01). Kaplan-Meier analysis revealed that the overall and recurrence-free survival of patients with cavitary adenocarcinoma was significantly shorter than that of patients with noncavitary adenocarcinoma (p < 0.001). Multivariate analysis revealed that cavity formation was an independent prognostic factor in adenocarcinoma (p = 0.028). Cavitary adenocarcinoma has worse prognostic clinicopathologic characteristics than noncavitary adenocarcinoma. Based on this finding, cavitary and noncavitary adenocarcinoma tumors should be considered separate entities.