Patients with multiple nodules and a dominant lung adenocarcinoma have similar outcomes and survival compared with patients who have a solitary adenocarcinoma

Abstract

Objectives: Lepidic growth pattern lung adenocarcinoma commonly presents as a dominant lesion (DL) with associated pulmonary nodules either in the ipsilateral or contralateral lung fields, posing a challenge in clinical decision-making. These tumours may be clinically upstaged compared with those who present with solitary lesions and, as a result, may be offered different therapies. The purpose of this study is to compare recurrence rates, the development of new lesions and survival in patients with adenocarcinoma with a lepidic component presenting with a DL with or without additional nodules.

Methods: We performed a 13-year retrospective chart review of patients with lepidic growth pattern adenocarcinoma. Patients were grouped into a uninodular group (UG) if they presented with a solitary lesion and a multinodular group (MG) if they had a DL with additional nodules. Clinicopathological features, outcomes and survival between the two groups were analysed.

Results: A total of 149 patients were identified: 62 (42%) in the UG and 87 (58%) in the MG. In addition to the DL, 217 nodules were preoperatively identified in the MG: 60 were resected concomitantly with the DL, while 157 were radiologically surveyed. Invasive adenocarcinoma was the predominant pathological cell type in both groups. The median time of follow-up was 3 years [interquartile range (IQR) 1.9-5.1]. Local (1 vs 2%), regional (1 vs 3%) and distant recurrences (7 vs 4%) were detected, respectively, in the UG and the MG. In the UG, 20 new lesions were identified, while in the MG there were 28. Only 4 of 157 (2.5%) surveyed pre-existing lesions were found to be malignant and required further treatment. No statistically significant differences were observed in 5-year disease-free and overall survival between the UG and the MG (82.3 vs 83.8%, P = 0.254 and 86.7 vs 93.8%, P = 0.096, respectively).

Conclusions: We observed that patients with lepidic growth pattern adenocarcinoma presenting with a DL with associated secondary nodules appear to behave similarly to patients with a solitary lesion. Multiple nodules including those that are malignant in this specific subset of non-small-cell lung cancer should not be upstaged as advanced disease and patients should be treated with the same curative intent as those presenting with uninodular disease.

Keywords: Adenocarcinoma; Lung cancer surgery; Lung nodules; Multinodular; Outcomes; Uninodular.