Preoperative biopsy and tumor recurrence of stage I adenocarcinoma of the lung

Abstract

Purpose To evaluate whether preoperative biopsy affects the outcomes of patients undergoing at least lobectomy for stage I lung adenocarcinoma. Methods We reviewed the medical records of patients who underwent surgery for stage I lung adenocarcinoma between 2006 and 2013. Tumor recurrence and survival were compared between patients who underwent preoperative biopsy, including computed tomographic-guided needle biopsy and transbronchial biopsy, and those who underwent intraoperative frozen section. Results Among 509 patients, 229 patients (44.9%) underwent preoperative biopsy and 280 patients had lung adenocarcinoma diagnosed by intraoperative frozen section (reference group). Recurrence developed in 65 (12.8%) patients within a median follow-up period of 54.4\xa0months. Multivariate analysis demonstrated that preoperative biopsy (OR 1.97, p \u2009=\u20090.045), radiological solid appearance (OR 5.43, p \u2009<\u20090.001), and angiolymphatic invasion (OR 2.48, p \u2009=\u20090.010) were independent predictors of recurrence. In the overall cohort, preoperative biopsy appeared to worsen 5-year disease-free and overall survival significantly (76.6% vs. 93.0%, p \u2009<\u20090.001; and 83.8% vs. 94.5%, p \u2009=\u20090.002, respectively) compared with the reference group. After propensity matching, multivariable logistic regression still identified preoperative biopsy as an independent predictor of overall recurrence (OR 2.21, p \u2009=\u20090.048) after adjusting for tumor characteristics. Conclusion Preoperative biopsy might be considered a prognosticator of recurrence of stage I adenocarcinoma of the lungs in patients who undergo at least anatomic lobectomy without postoperative adjuvant chemotherapy.