Cancer Res Treat.  2025 Apr;57(2):387-400. 10.4143/crt.2024.560.

Association of Shorter Time to Recurrence and Recurrence-Free Survival with Transthoracic Lung Biopsy in Stage I Lung Cancer

• Chae KJ
• Hong H
• Park H
• Yoon SH

• KMID: 2566858
• DOI: http://doi.org/10.4143/crt.2024.560

Abstract

Purpose
We aim to determine whether preoperative percutaneous needle aspiration or biopsy (PCNA/Bx) increases recurrence risk and reduces survival in stage I lung cancer patients, using a nationwide lung cancer registry.
Materials and Methods
We retrospectively included 3,452 patients diagnosed with stage I lung cancer who underwent curative surgery between 2014 and 2019, as recorded in the Korean Association of Lung Cancer Registry. To balance the characteristics of patients with and without PCNA/Bx, we applied inverse probability of treatment weighting. We used cumulative incidence plots and a weighted subdistribution hazard model to analyze time to recurrence. Recurrence-free survival and overall survival were analyzed using Kaplan-Meier curves and weighted Cox proportional hazard ratio models.
Results
In patients with adenocarcinoma, the use of PCNA/Bx was associated with a 1.9-fold increase (95% confidence interval [CI], 1.5 to 2.4) in the risk of recurrence and a 1.7-fold decrease (95% CI, 1.3 to 2.2) in recurrence-free survival. Subgroup analysis based on pathologic pleural invasion revealed that the risk of recurrence increased when PCNA/Bx was performed, with 2.1-fold (95% CI, 1.5 to 2.8) in patients without pleural invasion and 1.6-fold (95% CI, 1.0 to 2.4) in those with pleural invasion. No association was found between the use of PCNA/Bx and overall survival.
Conclusion
Preoperative PCNA/Bx was associated with increased recurrence risks in stage I adenocarcinoma, regardless of pathologic pleural invasion status. In early lung cancer cases where adenocarcinoma is strongly suspected and curative surgery is feasible, the use of transthoracic biopsy should be approached with caution.

Keyword

Lung neoplasms; Biopsy; Recurrence; Survival

Figure

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  Fig. 1. Patient selection diagram. BMI, body mass index; KALC-R, Korean Association of Lung Cancer Registry; PCNA/Bx, preoperative percutaneous needle aspiration or biopsy.

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  Fig. 2. Cumulative incidence of cancer recurrence by diagnostic procedure. (A) Without applying inverse probability of treatment weighting (IPTW), lung cancer recurrence at 12 and 36 months was 3.9% and 15.2% for preoperative percutaneous needle aspiration or biopsy (PCNA/Bx), significantly higher than the other diagnostic procedures (2.2% and 8.7%). (B) Applying IPTW, PCNA/Bx showed 12- and 36-month recurrence rates of 3.4% and 13.5%, still higher other diagnostic procedure rates of 2.4% and 9.6%.

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  Fig. 3. Cumulative incidence of recurrence by the presence of pleural invasion and diagnostic procedure in stage I patients. (A) When inverse probability of treatment weighting (IPTW) was not applied, patients with pleural invasion who underwent preoperative percutaneous needle aspiration or biopsy (PCNA/Bx) exhibited the highest lung cancer recurrence at 12 and 36 months (7.0% and 25.3%, respectively). Subsequently, the groups with pleural invasion but without PCNA/Bx (4.9% and 16.6%), those without pleural invasion who underwent PCNA/Bx (3.0% and 12.0%), and finally, those without pleural invasion who did not undergo PCNA/Bx (1.8% and 7.6%), demonstrated progressively lower rates of cancer recurrence. (B) After the application of IPTW, consistent trends remained. Among patients with pleural invasion, those who underwent PCNA/Bx displayed the most significantly elevated lung cancer recurrence at 12 and 36 months (5.9% and 23.4%, respectively). Subsequently, the groups with pleural invasion but without PCNA/Bx (4.5% and 16.5%, respectively), those without pleural invasion who underwent PCNA/Bx (2.8% and 11.3%, respectively), and finally, those without pleural invasion who did not undergo PCNA/Bx (2.0% and 8.2%, respectively), demonstrated progressively lower rates of cancer recurrence.

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  Fig. 4. Recurrence-free survival by diagnostic procedure. (A) Before applying inverse probability of treatment weighting (IPTW), the recurrence-free survival rates at 12 and 36 months for preoperative percutaneous needle aspiration or biopsy (PCNA/Bx) were 4.4% and 17.0%, respectively, which were significantly higher than those observed with other diagnostic procedures (3.0% and 10.8%, respectively). (B) After applying IPTW, the 12- and 36-month recurrence-free survival rates for PCNA/Bx were 3.8% and 15.0%, respectively, which remained higher than other diagnostic procedure (3.3% and 11.8%, respectively).

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  Fig. 5. Overall survival by diagnostic procedure. (A) Without applying inverse probability of treatment weighting (IPTW), the 3- and 5-year survival probabilities for preoperative percutaneous needle aspiration or biopsy (PCNA/Bx) were 92.4% and 56.6%, respectively, which did not differ significantly from the observed with other diagnostic procedures (93.5% and 68.1%, respectively). (B) With IPTW applied, PCNA/Bx demonstrated 3- and 5-year survival rates of 93.2% and 57.9%, respectively, which remained comparable to the rates of 92.8% and 67.4%, respectively, associated with other diagnostic procedures.

Reference

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