Clinical and Pathologic Prognostic Factors That Are Influential in the Survival and Prognosis of Lung Adenocarcinomas and Invasive Predominant Subtypes

Abstract

Therapeutic approaches to lung adenocarcinomas differ because of their heterogeneous morphologies, prognoses, and clinical features. For this reason, new histopathologic classifications for lung adenocarcinomas were done by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society to form subtypes with homogeneous prognoses. There are limited clinical data in the literature on the prognosis of the subgroups formed according to the new classification. A total of 86 patients with adenocarcinoma who had undergone pathologic stages I and II curative resection and mediastinal lymph node dissection were retrospectively analyzed according to the seventh TNM staging system revised by the Union for International Cancer Control/American Joint Committee on Cancer. Histologic subtyping was reassessed according to the dominant histopathologic morphology. When survival rates of lung adenocarcinomas were compared according to their localizations, it was observed that adenocarcinomas localized to the right hemithorax had a longer survival than the ones with left hemithorax localization (P = 0.026). When necrosis was taken into account, it was seen that necrosis rate was higher in solid predominant type compared with other types, whereas it was lower in acinary type (P = 0.046). When peritumoral lymphovascular invasion data were assessed, it was observed that disease-free survival was influenced in a negative fashion (P = 0.018). New histopathologic classification of adenocarcinomas has been a step forward to attaining homogeneous groups, but when the biologic heterogeneity of the adenocarcinomas is taken into account, the authors believe that considering the peritumoral lymphatic vascular invasion, left hemithorax localization, and tumoral necrosis entities in the upcoming TNM classification will contribute to evaluating the prognosis.

Pathologic stratification of operable lung adenocarcinoma using radiomics features extracted from dual energy CT images

“…The prognostic impact of pathologic invasiveness and the need to predict pathologic invasiveness have been described in many studies. Histologic subtypes defined by IASLC/ATS/ERS classification and other pathologic factors such as lymph node involvement and pleural and vessel invasion are known to show correlation with the survival outcome [ 14 , 15 ]. Consequently, in the clinical setting accurate prediction of pathologic invasiveness may aid the decision for an appropriate operation type based on the status of the tumor.…”

“…Major lung resection has been recommended as a standard procedure for the treatment of lung adenocarcinoma, but according to recent literature limited surgical resection could be used instead for cases of small-sized lung cancer [ 16 – 20 ]. Meanwhile, some studies have emphasized the importance of stratifying early-stage NSCLC patients to select candidates for adjuvant therapy [ 14 , 15 ]. The presence of the micropapillary or solid subtype has been shown to be a poor prognostic factor for overall survival and for recurrence in patients with NSCLC [ 21 , 22 ] and Travis et al [ 21 ] suggested that micropapillary or solid predominant subtype predicts improved responsiveness to adjuvant chemotherapy compared with acinar or papillary predominant tumors in patients with surgically resected lung adenocarcinoma [ 23 ].…”