Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience

Abstract

The recent proposal for histological subtyping of pulmonary adenocarcinoma by predominant pattern and introduction of the terms adenocarcinoma in situ and minimally invasive adenocarcinoma to replace the term bronchioloalveolar carcinoma by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society has led us to conduct a study of 104 patients with early-stage primary pulmonary adenocarcinoma (T1N0M0), with a view to histological subtype as defined by the new proposal and clinical outcome. None of the clinical parameters of our patient population (type of surgery, age, gender, tumor size, and comorbidities) showed any statistically significant correlation with outcome, except for associated malignancies, which not surprisingly appeared to have a negative impact on survival. In addition, statistical analyses of the histological characteristics to include tumor differentiation and the percentage of a lepidic or bronchioloalveolar component did not show any statistically significant values in terms of survival. Our results failed to show any statistically significant difference of survival between those T1N0M0 adenocarcinomas with a lepidic component and those without, thus questioning the use of terms such as in situ or minimally invasive adenocarcinoma. On the basis of our results, we consider that the outcome for patients with T1N0M0 disease is still best determined by appropriate staging rather than by changes in the pathology nomenclature of adenocarcinoma. The number of deaths due to lung cancer among this group was approximately 158 thousand. Also according to SEER, the age group more commonly affected is individuals between the ages of 55 and 74 years, with a median age at diagnosis of 71 years. Although lung cancer is also seen in younger age groups, people under 45 years of age represent approximately 2% of the total number of cases, while those people between the ages of 45 and 54 years represent approximately 9% of the total number of cases. It is also suggested that factors such as smoking, dietary habits, family history, and chemical exposure to compounds such as asbestos, radon, and silica among many others may play a role in lung cancer pathogenesis. Of all the different types of lung cancer, adenocarcinoma is currently the most frequent.In an effort to better define clinical behavior regarding small size adenocarcinomas, various studies have used different ways to address this issue.

Prognostic Significance of Adenocarcinoma In Situ, Minimally Invasive Adenocarcinoma, and Nonmucinous Lepidic Predominant Invasive Adenocarcinoma of the Lung in Patients With Stage I Disease

“…53, 54 Recent studies that have failed to demonstrate significance of adenocarcinoma histologic subtyping used overall survival rather than survival linked to recurrence such as DFS or CIR. 55, 56 Furthermore, a recurrence must be distinguished from a metachronous primary, as may have occurred in the single case of development of an additional lung nodule in a different lobe of the same lung in one of the MIA cases reported by Xu et al 57 As raised in our study, it may also be important to take into consideration if lepidic predominant adenocarcinoma underwent limited resection with a close margin as it can be very difficult to assess lepidic growth at a staple line margin.…”

Case of the Season: Management of the Subsolid Pulmonary Nodule

“…12 On CT, lung adenocarcinoma may demonstrate variable appearances including pure GGN (ground-glass components only), part-solid nodules or mixed GGN, and solid nodules or masses (no ground-glass components). 13 Serial CT findings have demonstrated that stepwise progression of lesions with ground-glass opacity, manifested as an increase in size or increase of solid components, does occur in select cases and correlates with a potential association between SSNs and peripheral lung adenocarcinomas. 14 As reported by Henschke et al, 6 in a population of high-risk individuals screened with low-dose CT, there is a greater rate of proven malignancy for part-solid (63%) nodules than pure GGN (18%) or solid nodules (7%).…”

Pre-operative Prediction of Ki-67 Expression in Various Histological Subtypes of Lung Adenocarcinoma Based on CT Radiomic Features

“…However, many patients, even patients with resectable lung cancer, still have poor prognoses ( 3 ). For lung adenocarcinoma, studies have found that, even for patients with complete surgical resection and in pathologic stage T1 (pathologic-T1, pT1), the treatment effects and prognoses may be significantly different ( 4 ). There is an urgent need to determine reliable prognostic factors that can predict clinical outcomes and more precisely stratify the group of patients susceptible to poorer outcomes.…”