Ayçim ŞEN, Akın ÖZTÜRK, İrfan YALÇINKAYA, Murat KAVAŞ, Elçin ERSÖZ, Onur DERDİYOK, Abdurrahman YILMAZ, Cansel ATİNKAYA BAYTEMİR, Sevinç ÇITAK

Prognosis analysis according to the predominant histological pattern in cases with lung adenocarcinoma undergoing complete resection

Lung adenocarcinoma accounts for over 40% of lung cancer cases. There is still uncertainty in terms of prognosis, particularly because of limited pathological information among the predominant sub-patterns of adenocarcinomas. In this study, we evaluated the prognostic relationship with the predominant histological patterns in adenocarcinoma cases that underwent complete resection in one year. We retrospectively evaluated 100 patients with lung adenocarcinoma, whose pathological stage was determined after complete resection. Six patients were excluded from the study because of missing data in their files. The mortality rates and tumor stages of the patients were analyzed according to their histopathological subtypes with the predominant pattern. Seventy-four (79%) of the cases were male and 20 (21%) were female. The predominant pattern was solid in 41 (43.6%) patients, acinar in 31 (33%) patients, papillary in 10 (10.6%) patients, lepidic in 9 (9.6%) patients and micropapillary in 3 (3.2%) patients. Lymph node involvement was N0 in 30 (73.2%) patients, N1 in 9 (22%) patients and N2 in 2 (4.9%) patients in the solid group; N0 in 22 (71%) patients, N1 in 3 (9.7%) patients, and N2 in 6 (19.4%) patients in the acinar group. In the solid group, 23 (56.1%) patients survived, and 18 (14.6%) patients died, whereas 21 (67.7%) patients survived, and 10 (32.2%) patients died in the acinar group. The mean follow-up period of the patients was 32 months. In the mean follow-up of all patients, 58 (61.7%) survived and 36 (38.3%) died. No significant difference was observed between the subtypes in terms of mortality (p>0.05). N2 involvement was higher in acinar adenocarcinomas compared with the solid pattern, and the advanced stage due to the T factor was observed more in the solid pattern. Acinar-type adenocarcinoma shows similar prognostic characteristics to those with the solid pattern.

PDF

___

1. Kim HS, Hoseok I, Choi YS, et al. Surgical resection of recurrent lung cancer in patients following curative resection. J Korean Med Sci. 2006; 21:224-8.
2. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society / European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6:244-85.
3. Campos-Parra AD, Aviles A, Contreras-Reyes S, et al. Relevance of the novel IASLC/ ATS/ERS classification of lung adenocarcinoma in advanced disease. Eur Respir J. 2014;43:1439-47.
4. Motoi N, Szoke J, Riely GJ, et al. Lung adenocarcinoma: modification of the 2004 WHO mixed subtype to include the major histologic subtype suggests correlations between papillary and micropapillary adenocarcinoma subtypes, EGFR mutations and gene expression analysis. Am J Surg Pathol. 2008;32:810-27.
5. Yoshizawa A, Motoi N, Riely GJ, et al. Impact of proposed IASLC/ATS/ ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Mod Pathol. 2011;24:653-64.
6. Sakao Y, Sakuragi T, Natsuaki M, et al. Clinicopathological analysis of prognostic factors in clinical IA peripheral adenocarcinoma of the lung. Ann Thorac Surg. 2003; 75:1113-17.
7. Tang ER, Schreiner AM, Pua BB. Advances in lung adenocarcinoma classification: a summary of the new international multidisciplinary classification system (IASLC/ATS/ERS). J Thorac Dis. 2014;6:489-501.
8. Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival ?: A clinicopathologic study based on the new International Association for the Study of Lung Cancer /American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer. 2011;6:1496-504.
9. Warth A, Muley T, Meister M, et al. The novel histologic IASLC/ATS/ERS classification of invasive pulmonary adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol. 2012;30:1438-46.
10. Shim HS, Kenudson M, Zheng Z, et al. Unique genetic and survival characteristics of invasive mucinous adenocarcinoma of the lung. J Thorac Oncol. 2015;10:1156-60.
11. Matsuzawa R, Kirita K, Kuwata T, et al. Factors influencing the concordance of histological subtype diagnosis from biopsy and resected specimens of lung adenocarcinoma. Lung Cancer. 2016;94:1-6.
12. Warth A, Cortis J, Fink L, et al. Pulmonary Pathology Working Group of the German Society of Pathology, Training increases concordance in classifying pulmonary adenocarcinomas according to the novel IASLC/ ATS/ERS classification. Virchows Arch. 2012;461:185-93.
13. Lee HY, Cha MJ, Lee KS, et al. Prognosis in resected invasive mucinous adenocarcinomas of the lung: related factors and comparison with resected nonmucinous adenocarcinomas. J Thorac Oncol. 2016;11:1064-73.
14. Lin G, Li H, Kuang J, et al. Acinar-predominant pattern correlates with poorer prognosis in invasive mucinous adenocarcinoma of the lung. Am J Clin Pathol. 2018;149:373-8.