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. 2022 Dec 23:12:1090544.
doi: 10.3389/fonc.2022.1090544. eCollection 2022.

Minor histological components predict the recurrence of patients with resected stage I acinar- or papillary-predominant lung adenocarcinoma

Wei Liu  1   2 , Qian Zhang  1   2 , Tiantian Zhang  1   2 , Li Li  1   2 , Chunhua Xu  1   2
Affiliations

Minor histological components predict the recurrence of patients with resected stage I acinar- or papillary-predominant lung adenocarcinoma

Wei Liu et al. Front Oncol. .

Abstract

Objective: Invasive lung adenocarcinoma is composed of five different histological subgroups with diverse biological behavior and heterogeneous morphology, the acinar/papillary-predominant lung adenocarcinomas are the most common subgroups and recognized as an intermediate-grade group. In the real world, clinicians primarily consider predominant patterns and ignore the impact of minor components in the prognosis of lung adenocarcinoma. The study evaluated the clinicopathologic characteristics of the lepidic, solid, and micropapillary patterns as non-predominant components and whether the minimal patterns had prognostic value on acinar/papillary-predominant lung adenocarcinomas.

Methods: A total of 153 acinar/papillary-predominant lung adenocarcinoma patients with tumor size ≤4 cm were classified into four risk subgroups based on the presence of lepidic and micropapillary/solid components: MP/S-Lep+, MP/S+Lep+, MP/S-Lep-, and MP/S+Lep- groups. The Cox-proportional hazard regression model was used to assess disease-free survival (DFS).

Results: The risk subgroups based on the non-predominant patterns were associated with differentiation (P = 0.001), lymphovascular invasion (P = 0.001), and recurrence (P = 0.003). In univariate analysis, DFS was correlated with non-predominant components (P = 0.014), lymphovascular invasion (P = 0.001), carcinoembryonic antigen (CEA) (P = 0.001), and platelet-to-lymphocyte ratio (PLR) (P = 0.012). In the multivariate analysis, non-predominant components (P = 0.043) and PLR (P = 0.032) were independent prognostic factors for DFS. The 5-year survival rates of MP/S-Lep+, MP/S+Lep+, MP/S-Lep- and MP/S+Lep- subgroups were 93.1%,92.9%,73.1%,61.9%, respectively. The MP/S-Lep+ subgroup had the favorable prognosis than MP/S+Lep- subgroup with a statistically significant difference (P = 0.002). As minor components, the lepidic patterns were a protective factor, and the solid and micropapillary components were poor factors. The recurrence was related to the presence of non-predominant patterns rather than their proportion. Adjuvant chemotherapy did not significantly improve the prognosis of the MP/S+Lep- subgroup (P = 0.839).

Conclusions: Regardless of the proportion, the presence of micropapillary/solid components and the absence of lepidic patterns are aggressive factors of DFS in patients with resected stage I acinar- or papillary-predominant lung adenocarcinoma.

Keywords: histological subtype; lung adenocarcinoma; non-predominant patterns; prognosis; stage I.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor HL declared a shared parent affiliation with the authors at the time of review.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves for analysis of using CEA and PLR in predicting disease-free survival.
Figure 2
Figure 2
Kaplan-Meier curve of DFS according to lepidic, micropapillary/solid minor components in stage I lung adenocarcinoma patients. The comparison of DFS between 2 groups: MP/S−Lep+ vs. MP/S+Lep− group (P = 0.002), MP/S−Lep+ vs. MP/S−Lep− group (P=0.042), MP/S+Lep+ vs. MP/S+Lep− group (P = 0.031), MP/S−Lep− vs. MP/S+Lep− group (P = 0.276), MP/S−Lep+ vs. MP/S+Lep+ group (P = 0.976), MP/S-Lep- vs. MP/S+Lep+ group (P = 0.135).
Figure 3
Figure 3
Subgroup analysis. (A) Comparison of DFS in patients with lung adenocarcinoma based on presence or absence of lepidic minor component. (B) Comparison of DFS in patients with lung adenocarcinoma based on the presence or absence of micropapillary/solid minor components component. (C) Comparison of DFS in patients with lung adenocarcinoma based on the proportion of micropapillary/solid minor components component. (D) Comparison of the effect of the presence or absence of lepidic component on DFS in patients with the micropapillary/solid minor component. The symbol of “&” means and.
Figure 4
Figure 4
Survival outcomes regarding disease-free survival based on the strategy of adjuvant chemotherapy.
See this image and copyright information in PMC

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