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. 2021 Feb;123(2):560-569.
doi: 10.1002/jso.26292. Epub 2020 Nov 10.

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
Affiliations

Prognostic impact of lung adenocarcinoma second predominant pattern from a large European database

Pietro Bertoglio et al. J Surg Oncol. 2021 Feb.

Abstract

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.

Keywords: lung adenocarcinoma; lung cancer biology; lung cancer surgery; non-small-cell lung cancer.

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