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Background We investigated the patterns and timing of recurrence and death as well as prognostic factors based on clinicopathological and radiological factors in patients who underwent surgical treatment for invasive mucinous adenocarcinoma (IMA). Methods We reviewed clinicopathological findings including spread through air spaces (STAS) and CT findings of IMA such as morphology, solidity, margin, well-defined heterogeneous ground-glass opacity, CT angiogram, and air bronchogram signs from 121 consecutive patients who underwent surgical resection. Prognostic factors for disease-free survival (DFS) and overall survival (OS) were identified. Hazard rate analyses were performed for the survival dynamics. Results T stage (hazard ratio [HR] = 4.102,  p  = 0.03), N stage (N2 vs. N0, HR = 7.653,  p  &lt; 0.001), and consolidative CT morphology (HR = 3.556,  p  = 0.008) remained independent predictors for DFS. Age (HR = 1.110,  p  = 0.002), smoking (HR = 12.893,  p  &lt; 0.001), T stage (HR = 13.005,  p  = 0.006), N stage (N2 vs. N0, HR = 7.653,  p  = 0.004), STAS (HR = 7.463,  p  = 0.008), and consolidative CT morphology (HR = 6.779,  p  = 0.007) remained independent predictors for OS. Consolidative morphology, higher T and N stage, and presence of STAS revealed initial sharp peaks after steep decline of the hazard rate curves for recurrence or death in follow-up period. Conclusions Consolidative morphology, higher T and N stage, smoking, and STAS were indicators of significantly greater risk of early recurrence or death in patients with IMA. Thus, these findings could be incorporated into future surveillance strategies.

Recurrence dynamics after curative surgery in patients with invasive mucinous adenocarcinoma of the lung