Micropapillary or solid pattern predicts recurrence free survival benefit from adjuvant chemotherapy in patients with stage IB lung adenocarcinoma

Abstract

Background: Our study aimed to evaluate the prognostic significance and adjuvant chemotherapy (ACT) benefits of a micropapillary/solid (MS) pattern in patients with stage IB lung adenocarcinoma.Methods: Patients with pathologically-confirmed stage IB adenocarcinoma who underwent surgical resection between January 2009 and December 2011 were included. The tumors were reclassified into three categories: MS patterns absent (MS−); non-predominant MS patterns (MS+); predominant MS (MS++). The correlations of prognosis and ACT with recurrence-free survival (RFS) were evaluated. Results: Overall, 497 (MS−, n=269; MS+, n=177; MS++, n=51) patients were enrolled in the study. In univariate analysis, the MS+ [hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.030-2.006; P=0.033] and MS++ (HR, 2.818; 95% CI, 1.792-4.432; P<0.001) groups had significantly poor prognosis compared with MS-group. Multivariate analysis revealed that age ≥65 (HR, 1.504; 95% CI, 1.077-2.099; P=0.017), serum level of carcinoembryonic antigen (CEA) ≥10 ng/mL (HR, 1.658; 95% CI, 1.048-2.623; P=0.031) and MS++ (HR, 2.529; 95% CI, 1.550-4.126; P<0.001) were significant prognostic factors. Furthermore, subgroup analysis showed that MS++ patients but not MS− and MS+ derived RFS (recurrence-free survival) benefit from ACT (HR, 0.357; 95% CI, 0.152-0.836; P=0.018). Conclusions: MS pattern successfully differentiated the prognosis difference among stage IB lung adenocarcinomas and identified patients who benefitted from ACT.

New International Association for the Study of Lung Cancer (IASLC) Pathology Committee Grading System for the Prognostic Outcome of Advanced Lung Adenocarcinoma

“…This highlights that those with poorly differentiated adenocarcinoma might fare worse than the other groups with systemic chemotherapy, which is similar to previous research showing that major solid patterns indicate inferior OS after systemic treatment [ 9 ]. Nevertheless, this result seems to conflict with other studies’ conclusions [ 36 , 37 , 38 , 39 ]. It is possible that different regimens may influence survival, especially as the method of chemotherapy can vary over time [ 29 ].…”

Clinical efficacy of adjuvant chemotherapy in stage IB (< 4 cm) non-small cell lung cancer patients with high-risk factors

“…And, patients who had undergone wedge resection and those who had an unknown lymph node status (Nx) were also excluded as they limited accurate stage evaluation. Since a micropapillary pattern is a pathological predictor of recurrence, it was considered a high-risk factor in this study [8][9][10]. Furthermore, previous studies have shown that lymphatic invasion is associated with recurrence [11,12].…”

Could tumor spread through air spaces benefit from adjuvant chemotherapy in stage I lung adenocarcinoma? A multi-institutional study

“…Patients were excluded from the study cohort if one of the following criteria was met: (1) receipt of induction therapy; (2) presence of multiple primary lung cancers; (3) receipt of targeted therapy or immunotherapy; (4) lack of information on lymph nodes status. Platinum-based ACT (cisplatin plus docetaxel or pemetrexed) was performed in patients with high-risk factors including poor differentiated tumor, visceral pleural invasion, vascular invasion, and SR. 8 Age, performance status, and patients’ preference were also considered. No mortality related to chemotherapy was detected among patients who underwent four cycles of ACT.…”

“… 6 Hitherto, several studies have reported potential survival advantages of ACT in stage IB patients with high-grade (micropapillary/solid-predominant) ADC. 7 , 8 In recent years, tumor spread through air spaces (STAS), has been recognized as a novel invasion pattern in stage I ADCs, which was associated with poor recurrence-free and overall survival. 9 – 11 Increasing evidence has revealed a potential relationship between resection types and patient survival in STAS-positive ADC.…”