New IASLC/ATS/ERS Classification and Invasive Tumor Size are Predictive of Disease Recurrence in Stage I Lung Adenocarcinoma Naoki Yanagawa, MD, PhD,

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New IASLC/ATS/ERS Classification and Invasive Tumor Size are Predictive of Disease Recurrence in Stage I Lung Adenocarcinoma Naoki Yanagawa, MD, PhD, Satoshi Shiono, MD, PhD, Masami Abiko, MD, PhD, Shin-ya Ogata, MD, PhD, Toru Sato, MD, PhD, Gen Tamura, MD, PhD Journal of Thoracic Oncology Volume 8, Issue 5, Pages 612-618 (May 2013) DOI: 10.1097/JTO.0b013e318287c3eb Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Nonmucinous adenocarcinoma in situ. This tumor shows growth restricted to the neoplastic cells along the preexisting alveolar structures (lepidic growth), lacking stromal, vascular, or pleural invasion (original magnification: A, ×40; B,×200). Journal of Thoracic Oncology 2013 8, 612-618DOI: (10.1097/JTO.0b013e318287c3eb) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Nonmucinous minimally invasive adenocarcinoma. This tumor consists primarily of lepidic growth but with a small area of invasion. In the lower left area is the lepidic pattern, and in the right upper area is the invasive area (original magnification: A, ×40: B, ×200). The Masson elastic staining shows desmoplastic tumor stroma, bundles of black, broken elastic fiber, and infiltrating acinar adenocarcinoma with stromal invasion (original magnification: C, ×100; D, ×200 Masson elastic staining). Journal of Thoracic Oncology 2013 8, 612-618DOI: (10.1097/JTO.0b013e318287c3eb) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Major histopathologic patterns of invasive adenocarcinoma. A papillary adenocarcinoma consisting of malignant cuboidal to columnar tumor cells growing on the surface of the fibrovascular cores (original magnification: A, ×200). An acinar adenocarcinoma consisting of round- to oval-shaped malignant glands invading a fibrous stroma (original magnification: B, ×200). A solid adenocarcinoma with mucin consisting of sheets of tumor cells with abundant cytoplasm and mostly vesicular nuclei with several conspicuous nucleoli (original magnification: C, ×200). Journal of Thoracic Oncology 2013 8, 612-618DOI: (10.1097/JTO.0b013e318287c3eb) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 DFS of all the patients. The 5-year DFS of AIS and MIA was 100%; lepidic-predominant, 94.9%; papillary-predominant, 85.4%; acinar-predominant, 89.7%; solid-predominant, 54%. The predominant growth pattern was significantly correlated with DFS (p < 0.001, overall). DFS, disease-free survival; AIS, adenocarcinoma in situ; MIA, minimally invasive adenocarcinoma. Journal of Thoracic Oncology 2013 8, 612-618DOI: (10.1097/JTO.0b013e318287c3eb) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 A, Total tumor size was not correlated with DFS (p = 0.475, overall), however, B, invasive tumor size was significantly correlated with DFS (⩽0.5 cm/ > 0.5cm, ⩽1cm/ >1 cm, ⩽2 cm/>2 cm, ⩽3 cm/ >3cm, 100%/91.5%/85.9%/80.8%/66.7%% in 5-year DFS) (p = 0.006). DFS, disease-free survival. Journal of Thoracic Oncology 2013 8, 612-618DOI: (10.1097/JTO.0b013e318287c3eb) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 6 Lepidic component rate was correlated with DFS (0%/≥5%, <35%/≥35%, <70%/≥70%, 74.9%/83.4%/91.1%/100% in 5-year DFS) (p = 0.003, overall). DFS, disease-free survival. Journal of Thoracic Oncology 2013 8, 612-618DOI: (10.1097/JTO.0b013e318287c3eb) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions