Prognostic impact of lung adenocarcinoma second predominant pattern from a large European database
Pietro Bertoglio 1 , Giulia Querzoli 2 , Luigi Ventura 3 , Vittorio Aprile 4 , Maria A Cattoni 5 , Dania Nachira 6 , Filippo Lococo 6 , Maria Rodriguez Perez 7 , Francesco Guerrera 8 , Fabrizio Minervini 9 , Letizia Gnetti 10 , Diana Bacchin 4 , Francesca Franzi 11 , Guido Rindi 12 , Salvatore Bellafiore 13 , Federico Femia 8 , Andrea Viti 1 , Giuseppe S Bogina 2 , Peter Kestenholz 9 , Enrico Ruffini 8 , Massimiliano Paci 14 , Stefano Margaritora 6 , Andrea S Imperatori 5 , Marco Lucchi 4 , Luca Ampollini 3 , Alberto C Terzi 1
Background and objectives: Adenocarcinoma patterns could be grouped based on clinical behaviors: low- (lepidic), intermediate- (papillary or acinar), and high-grade (micropapillary and solid). We analyzed the impact of the second predominant pattern (SPP) on disease-free survival (DFS).
Methods: We retrospectively collected data of surgically resected stage I and II adenocarcinoma.
Selection criteria: anatomical resection with lymphadenectomy and pathological N0. Pure adenocarcinomas and mucinous subtypes were excluded. Recurrence rate and factors affecting DFS were analyzed according to the SPP focusing on intermediate-grade predominant pattern adenocarcinomas.
Results: Among 270 patients, 55% were male. The mean age was 68.3 years. SPP pattern appeared as follows: lepidic 43.0%, papillary 23.0%, solid 14.4%, acinar 11.9%, and micropapillary 7.8%. The recurrence rate was 21.5% and 5-year DFS was 71.1%. No difference in DFS was found according to SPP (p = .522). In patients with high-grade SPP, the percentage of SPP, age, and tumor size significantly influenced DFS (p = .016). In patients with lepidic SPP, size, male gender, and lymph-node sampling (p = .005; p = .014; p = .038, respectively) significantly influenced DFS.
Conclusions: The impact of SPP on DFS is not homogeneous in a subset of patients with the intermediate-grade predominant patterns. The influence of high-grade SPP on DFS is related to its proportion in the tumor.
CITATION J Surg Oncol. 2021 Feb;123(2):560-569. doi: 10.1002/jso.26292. Epub 2020 Nov 10