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. 2014:2014:645681.
doi: 10.1155/2014/645681. Epub 2014 Oct 12.

Prognostic implication of predominant histologic subtypes of lymph node metastases in surgically resected lung adenocarcinoma

Kenichi Suda  1 , Katsuaki Sato  1 , Shigeki Shimizu  2 , Kenji Tomizawa  1 , Toshiki Takemoto  1 , Takuya Iwasaki  1 , Masahiro Sakaguchi  1 , Tetsuya Mitsudomi  1
Affiliations

Prognostic implication of predominant histologic subtypes of lymph node metastases in surgically resected lung adenocarcinoma

Kenichi Suda et al. Biomed Res Int. 2014.

Abstract

The International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) proposed a new classification for lung adenocarcinoma (AD) based on predominant histologic subtypes, such as lepidic, papillary, acinar, solid, and micropapillary; this system reportedly reflects well outcomes of patients with surgically resected lung AD. However, the prognostic implication of predominant histologic subtypes in lymph nodes metastases is unclear so far. In this study, we compared predominant subtypes between primary lung tumors and lymph node metastatic lesions in 24 patients with surgically treated lung adenocarcinoma with lymph node metastases. Additionally, we analyzed prognostic implications of these predominant histologic subtypes. We observed several discordance patterns between predominant subtypes in primary lung tumors and lymph node metastases. Concordance rates were 22%, 64%, and 100%, respectively, in papillary-, acinar-, and solid-predominant primary lung tumors. We observed that the predominant subtype in the primary lung tumor (HR 12.7, P = 0.037), but not that in lymph node metastases (HR 0.18, P = 0.13), determines outcomes in patients with surgically resected lung AD with lymph node metastases.

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Figures

Figure 1
Figure 1
Representative photo-micrographs of primary lung tumors and metastatic lesions of lymph nodes. All of these four patients had papillary-predominant primary lung tumors (left), but developed lymph node metastases that were papillary-predominant (a), acinar-predominant (b), solid-predominant (c), and micropapillary-predominant (d), as shown on the right. Colored bar graphs indicate the proportion of histologic subtypes. In primary lung tumors (left), proportions of each histologic subtype present are estimated in 5% increments. Histologic subtypes in metastatic lymph nodes (right) were recorded as a binary variable.
Figure 2
Figure 2
Correlation between predominant histologic subtype in primary lung tumors and that in lymph node metastases. Inside pie chart indicates primary lung tumors; outside chart indicates lymph nodes. Each color represents each predominant histologic subtype as shown below the pie charts.
Figure 3
Figure 3
Kaplan-Meier survival curves for recurrence-free survival and overall survival stratified according to the predominant histologic subtypes of primary lung tumors (a and c) and metastatic lymph nodes (b and d). Grade II includes papillary/acinar-predominant lesions and Grade III includes solid/micropapillary-predominant lesions, according to the previous report [10].
See this image and copyright information in PMC

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