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A Novel Radiopathological Grading System to Tailor Recurrence Risk for Pathologic Stage IA Lung Adenocarcinoma.

To validate the efficiency of pathological grading system in pathological stage IA lung adenocarcinoma (LUAD), and explore whether integrating preoperative radiological features would enhance the performance of recurrence discrimination. We retrospectively collected 510 patients with resected stage IA LUAD between January 2012 and December 2019 from Guangdong Provincial People's Hospital (GDPH). Pathological grade classification of each case was based on the International Association for the Study of Lung Cancer (IASLC) pathological staging system. Kaplan-Meier curves was used to assess the power of recurrence stratification. Concordance index (C-Index) and receiver operating characteristic curves (ROC) were used for evaluating the clinical utility of different grading systems for recurrence discrimination. Patients of lower IASLC grade showed improved recurrence-free survival (RFS) (p<0.0001) where numerically difference was found between grade II and grade III (p=0.119). By integrating the IASLC grading system and radiological feature, we found the RFS rate decreased as the novel radiopathological (RP) grading system increased (p<0.0001). The difference of RFS curves between any two groups as per the RP grading system was statistically significant (RP grade I vs RP grade II, p = 0.007; RP grade I vs RP grade III, p<0.0001; RP grade II vs RP grade III, p=0.0003). Compared with the IASLC grading system, the RP grading system remarkably improved recurrence survival discrimination (C-index: 0.822; area under the curve, 0.845). Integrating imaging feature into pathological grading system enhanced the efficiency of recurrence discrimination for resected stage IA LUAD and might help conduct subsequent management.