The IASLC/ATS/ERS classification of lung adenocarcinoma-a surgical point of view

In the past decades, adenocarcinoma has become the most common histologic type of lung cancer. The tendency is similar in western populations as well as in China (1). In the meantime, management for adenocarcinomas of lung has gained significant improvement both in diagnostic and therapeutic approaches. With the application of computed tomography (CT) screening, ground glass nodules (GGN) often corresponding to early stage noninvasive or minimally invasive adenocarcinomas (MIA), which would have been difficult or even impossible to detect on routine chest X-ray, have been encountered more and more frequently in daily practice. On the other hand, only 20-30% of non-small cell lung cancer (NSCLC) patients is diagnosed with stage I-IIIa disease and thus may be amenable to surgical resection. Even for completely resected stage Ia NSCLC, 5-year survival is 73% only, with 27% of patients eventually dying from recurrent disease (2). And currently there is no accurate way to identify patients at high risk of recurrence, and thus would potentially benefit from adjuvant therapies