Objective: To study the clinicopathological features and prognostic significance of different pathological subtypes of T1 invasive lung adenocarcinoma for providing a reference for the monitoring and treatment strategy of lung adenocarcinoma. Methods: A total of 120 patients undergone surgical treatment and confirmed by postoperative pathology as invasive lung adenocarcinoma with tumor diameter less than or equal to 3 cm from Jan. 2009 to Jan, 2011 were enrolled. The patients were divided into five groups according to dominant pathological subtypes: lepidic group,acinar group, papillary group, micro-papillary group, and solid group. The clinical and pathological data of the patients were analyzed retrospectively. Kaplan-Meier method was used to calculate survival rate. Log-Rank test was used to compare survival difference. COX regression analysis was used to determine the risk factors of prognosis. Result: There were no significant differences in age, sex, CEA level and tumor differentiation between the five groups（P>0.05）. Meanwhile, there were significant differences in invasion of visceral pleura, lymph node metastasis, TNM stage and recurrence or metastasis after operation between the five groups（P<0.05）. Among the five subtypes, lymph node metastasis rate (62.5%) and postoperative recurrence rate (41.6%) were the highest in micro-papillary group. Survival analysis showed that lipidic group had the best prognosis, the 5 year survival rate was 96.0%; the prognosis of micro-papillary group was the worst, and the 5 year survival rate was 66.7%. The difference was statistically significant（P<0.05）. Pathological subtypes, lymph node metastasis and TNM staging were the risk factors influencing the prognosis of stage T1 invasive lung adenocarcinoma. Different pathological subtypes and lymph node metastasis were the independent prognostic factors (OR>1). Conclusions: The prognosis of T1 invasive adenocarcinoma of lung is related to pathological subtype and lymph node metastasis. Micro-papillary subtypes indicate higher lymph node metastasis and poor prognosis. More aggressive treatment and observation might be needed after operation of micro-papillary subtype of invasive lung adenocarcinoma.
DU Hailei, CHE Jiaming, ZHU Lianggang, LI Hecheng, HANG Junbiao
. Clinical characteristics of different pathological subtypes of T1 invasive lung adenocarcinoma and analysis of prognosis[J]. Journal of Diagnostics Concepts & Practice, 2018
, 17(01)
: 82
-86
.
DOI: 10.16150/j.1671-2870.2018.01.015
[1] 朱栋麟, 茹怡, 刘晓强, 等. T1期外周型肺癌临床病理特征及淋巴结转移分析[J]. 中国实用医药,2016,11(26):12-14.
[2] 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[J]. J Thorac Oncol,2011,6(9):1496-1504.
[3] Rainio P, Sutinen S, Sutinen SH.Histological subtypes or grading of pulmonary adenocarcinoma. A histochemical and electron microscopic study[J]. Acta Pathol Microbiol Immunol Scand A,1983,91(4):227-234.
[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[J]. Am J Surg Pathol,2008,32(6):810-827.
[5] Hoshi R, Tsuzuku M, Horai T, et al.Micropapillary clusters in early-stage lung adenocarcinomas: a distinct cytologic sign of significantly poor prognosis[J]. Cancer,2004, 102(2):81-86.
[6] Amin MB, Tamboli P, Merchant SH, et al.Micropapillary component in lung adenocarcinoma: a distinctive histologic feature with possible prognostic significance[J]. Am J Surg Pathol,2002,26(3):358-364.
[7] Miyoshi T, Satoh Y, Okumura S, et al.Early-stage lung adenocarcinomas with a micropapillary pattern, a distinct pathologic marker for a significantly poor prognosis[J]. Am J Surg Pathol,2003,27(1):101-109.
[8] Hung JJ.Histologic subtype component predicts lymph node micrometastasis and prognosis in patients with stage I lung adenocarcinoma[J]. J Thorac Dis,2017,9(10):3623-3625.
[9] Park JK, Kim JJ, Moon SW, et al.Lymph node involvement according to lung adenocarcinoma subtypes: lymph node involvement is influenced by lung adenocarcinoma subtypes[J]. J Thorac Dis,2017,9(10):3903-3910.
[10] Zhao W, Wang H, Xie J, et al.A Clinicopathological Study of Small Lung Adenocarcinoma 1 cm or Less in Size: Emphasis on Histological Subtypes Associated With Lymph Node Metastasis and Recurrence[J]. Int J Surg Pathol,2018,26(1):4-11.
[11] Yoshida Y, Nitadori JI, Shinozaki-Ushiku A, et al.Micropapillary histological subtype in lung adenocarcinoma of 2 cm or less: impact on recurrence and clinical predictors[J]. Gen Thorac Cardiovasc Surg,2017,65(5):273-279.
