DISCUSSION
NSCLC, tumor, pulmonary dysfunction, lung cancer, early‐stage lung cancer
TUMOR, RECURRENCE, METASTASIS, LUNG ADENOCARCINOMA, DISEASE, LUNG CANCER, NSCLC
In this study, we mainly used preoperative blood parameters to build a model which not only had prognostic value but could also provide a reference for thoracic surgeons when choosing resection before surgery. Patients at higher risk of recurrence may benefit from lobectomy resection, while the same effect could be achieved in sublobar resection patients at lower risk as surgeons can save more lung tissue. This finding makes great sense in patients of greater age or those with pulmonary dysfunction.Our cohort had some superiorities. First, it focused only on stage IA LUAD patients with a huge sample size, while previous studies concentrated on locally advanced disease or metastasis. Moreover, this model is the first prediction model to predict recurrence in stage IA LUAD patients only structured by preoperative blood parameters. Patients with early‐stage LUAD experience local recurrence and distant metastasis due to micrometastasis that cannot be detected by current technology.Nowadays, the indication for sublobar resection is still controversial. In terms of T1aN0 disease, it is suggested that the rate of local recurrence patients with sublobar resection is higher than lobectomy.In this study, we constructed a nomogram to distinguish stage IA patients who had a high risk of recurrence. We believe that serum markers play an important role in lung cancer treatment, but these markers are underestimated in the preoperative prediction of stage IA lung adenocarcinoma. As a tumor marker with a prognostic role in lung adenocarcinoma, CEA is conveniently detected during the postoperative period and has been widely used in clinical practice. However, in a previous study, the recommended pretreatment evaluation indicator of the NCCN guidelines for the management of NSCLC issued did not contain CEA.Serum albumin has also been shown to have prognostic value. Some studies have reported that albumin is associated with the prognosis of early‐stage lung cancer.In this study, we combined three blood parameters and confirmed that the prognostic value of the combination of these parameters was higher than each one alone which illustrates the necessity of the establishment of our nomogram. Due to the absence of specific markers, the prognosis of LUAD is always difficult. However, our nomogram accomplished this task, thus meeting the demand from clinical practice.Furthermore, we analyzed the difference of RFS in two risk groups with stratification by clinicopathological characteristics. The results showed that in the analysis of three subgroups, the trend of the probability of recurrence between the high‐ and the low‐risk groups could be distinguished according to Kaplan–Meier curves. Although the There are several issues to be considered with the findings of our study. First, we only focused on stage IA lung adenocarcinoma, while other studies mostly focused on NSCLC at all stages. Moreover, we only used the basic blood parameters that are essential for diagnosis and surgery. This indicates that our nomogram will be cost‐efficient and does not require the collection of other parameters. However, there are also other limitations. First, due to the retrospective characteristics of the study, the existence of bias is inevitable. Second, the parameters included in the nomogram may be affected by many factors. Third, our study was a single institution study, and multicenter studies are needed in the future.In conclusion, in this study, we discovered that gender, ALB, CEA, and Cyfra21‐1 are valuable prognostic variables in stage IA lung adenocarcinoma, which not only can help predict recurrence, but can also provide guidance for surgical practice. It should be emphasized that CEA, Cyfra21‐1, ALB monitoring during the preoperative period will provide valuable prognostic information for patients with IA stage lung adenocarcinoma. Higher levels of CEA and Cyfra21‐1 are connected with recurrence. On the contrary, higher levels of ALB and being female are protective factors. We suggest that patients with high levels of preoperative level of CEA and Cyfra21‐1 or low ALB level will benefit from lobectomy.