The Clinical Impact of Solid and Micropapillary Patterns in Resected Lung Adenocarcinoma: Author's Reply

Yanagawa, Naoki

doi:10.1016/j.jtho.2016.12.020

Cited by 4 publications

(6 citation statements)

References 4 publications

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“…The previous limited resected sample sizes of LADC were able to predict poor prognostic outcomes in early-stage disease, but the role of each subtype in predicting the prognosis during the late stage remains unclear [2,9,14,15,29]. In the current study, we showed that the use of the new grading system in patients with advanced stage disease is reproducible and applicable in clinical practice.…”

Section: Discussionmentioning

confidence: 55%

“…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]. Therefore, we still provided possible predictors of preterm treatment failure in patients receiving first-line chemotherapy based on the histologic predominant subtype.…”

Section: Discussionmentioning

confidence: 79%

“…Similar results have also been reported in other cohorts. It is generally accepted that patients with solid and/or micropapillary patterns have a worse prognosis whether or not the subtype is predominant [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

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

Weng

Huang

et al. 2020

Cancers

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The impact of the new International Association for the Study of Lung Cancer pathology committee grading system for advanced lung adenocarcinoma (LADC) on survival is unclear, especially in Asian populations. In this study, we reviewed the prognostic outcomes of patients with late-stage disease according to the new grading system. We reviewed 136 LADC cases who underwent a small biopsy from 2007 to 2018. Tumors were classified according to the new grading system for LADC. Baseline characteristics (age, sex, smoking status, body mass index, and driver gene mutations) were analyzed. Kaplan–Meier and Cox regression analyses were used to determine correlations with the new grading system and prognosis. Patients with poorly differentiated adenocarcinoma were significantly correlated with a poor progression-free survival (PFS) (p = 0.013) but not overall survival (OS) (p = 0.154). Subgroup analysis showed that wild-type EGFR patients with poorly differentiated adenocarcinoma treated with chemotherapy had significantly worse PFS (p = 0.011). There was no significant difference in survival among the patients with epidermal growth factor receptor mutations who were treated with tyrosine kinase inhibitors. Patients aged >70 years and those with a BMI ≤ 25 kg/m2 and wild-type patients had significantly worse OS in both univariate (HR = 1.822, p = 0.006; HR = 2.250, p = 0.004; HR = 1.537, p = 0.046, respectively) and multivariate analyses (HR = 1.984, p = 0.002; HR = 2.383, p = 0.002; HR = 1.632, p = 0.028, respectively). Despite therapy, patients with poorly differentiated tumors still fared worse than those with better differentiated tumors. No differences were found among the EGFR mutations treated with TKI. Our findings highlight that the therapeutic regimen should be adjusted for EGFR Wild-type patients with poorly differentiated adenocarcinoma treated with chemotherapy to provide better outcomes.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 79%

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

Weng

Huang

et al. 2020

Cancers

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“…In most studies, patients with ACI based and PAP-type tumors, the most common subtypes in patients with lung adenocarcinoma, which together account for the majority of invasive adenocarcinoma cases, have a similar prognosis, with lower survival rates than in patients with AIS or MIA but higher than for MIP or SOL. [ 23 , 24 ] Similarly, Yoshiya et al [ 25 ] showed that for invasive lung adenocarcinomas of ≤2 cm diameter, pathologic subtype is a significant independent predictor of recurrence-free survival and suggested that adjuvant chemotherapy is required after tumor resection, even in the absence of lymph node metastasis, for patients with MIP or SOL. In this study, we found no lymph node metastasis, regardless of tumor size, for AIS and MIA tumors, and for LEP tumors, lymph node metastasis was unlikely, and even if it did occur, it was mostly pN1.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of the relationship between the pathologic subtype and lymph node metastasis of lung adenocarcinomas of ≤3 cm diameter

et al. 2020

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To analyze the relationship between pathologic subtype and lymph node metastasis for lung adenocarcinomas of ≤3 cm diameter. We retrospectively studied 384 patients with operable lung adenocarcinomas of ≤3 cm diameter that had been radically resected by lobectomy or anatomic segmentectomy with systematic nodal dissection, at the Fujian Medical University Union Hospital between March 2014 and March 2016. Lymph node metastasis pN1 + pN2 (pN+) was found in 2 of 104 (1.9%) patients with tumor diameter ≤1.0 cm, 12 of 159 (7.5%) patients with tumor diameter >1.0 cm but ≤2.0 cm, and 35 of 121 (28.9%) patients with tumor size >2.0 cm but ≤3.0 cm ( P < .01). Lymph node metastasis pN+ was found in 19 of 53 (35.8%) patients with visceral invasion pleural (VIP) and 30 of 331 (9.0%) patients without VIP ( P < .05). It was also found in 16 of 51 (31.3%) patients with high serum CEA concentrations and 28 of 297 (9.4%) patients with normal concentrations ( P < .05). In a multivariate analysis, tumor diameter, VIP, high serum CEA concentration, and pathologic subtype were significant risk factors. The prevalences of lymph node metastasis pN+ were: 0.0% (0/2), 0.0% (0/89), 3.2% (1/31), 16.2% (34/209), 7.7% (1/13), 46.7% (7/15), 100% (4/4), and 11.8% (2/17) for adenocarcinoma in situ (AIS); minimally invasive adenocarcinoma (MIA); predominantly lepidic (LEP), acinar (ACI), papillary, solid (SOL), and micropapillary (MIP) tumors; and variants of invasive adenocarcinoma, respectively ( P < .05). For predominant SOL and MIP tumors, the prevalences of lymph node involvement were significantly higher than for the other subtypes. We have shown that lymph node metastasis in patients with tumor diameter ≤3 cm differs according to lung adenocarcinoma subtype. AIS and MIA were not associated with lymph node metastasis; therefore, systematic nodal dissection may be unnecessary. The prevalence of lymph node metastasis rate was low for LEP, suggesting that systemic lymph node sampling is sufficient. In contrast, for other pathologic subtypes, including SOL and MIP, systematic lymph node dissection should be performed.

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“…Patients with small (≤3 cm) non−small cell lung carcinoma (NSCLC) who undergo limited resection (LR) have a higher incidence of locoregional recurrence than patients who undergo lobectomy 1. Through efforts to identify risk factors associated with higher rates of locoregional recurrence, we and others have shown that micropapillary (MIP) and/or solid (SOL) histologic subtype and the presence of tumor spread through air spaces (STAS) are associated with a high risk of recurrence 2–8. Unlike the traditional forms of tumor invasion, such as lymphovascular, stromal, and pleural invasion, STAS is present in air spaces of the normal lung beyond the tumor edge.…”

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confidence: 99%

Spread Through Air Spaces (STAS) in Non−Small Cell Lung Carcinoma

Gross¹,

Hsieh

Yan

et al. 2021

American Journal of Surgical Pathology

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Tumor spread through air spaces (STAS) is associated with locoregional recurrence in patients undergoing limited resection (LR) for non−small cell lung carcinoma (NSCLC). We hypothesized that the observation of STAS in both the initial LR specimen and the additional resection specimen from the same patient, processed using different knives, would provide evidence that STAS is an in vivo phenomenon contributing to locoregional recurrence. We retrospectively identified patients with NSCLC (9 adenocarcinoma, 1 squamous cell carcinoma) who underwent LR, had STAS in the LR specimen, and underwent additional resection (lobectomy or LR). The LR and additional resection specimens from each patient were processed at different times using different tissue-processing knives. All specimens were analyzed for STAS. All 10 patients underwent LR with negative margins (R0). All additional resection specimens had STAS: 8 patients had STAS clusters in their completion lobectomy specimens, and 2 had STAS in their additional LR specimens. In 2 patients, STAS was found in the completion lobectomy specimen only after extensive sampling (>10 sections) from the staple line adjacent to the initial LR. The presence of STAS in both the LR and the additional resection specimen processed using different knives supports the concept that STAS is an in vivo phenomenon, rather than an artifact from tissue processing. This observation indicates that occult STAS tumor cells can be present in the lung tissue of the remaining unresected lobe after LR and supports the concept that STAS is a contributing factor for locoregional recurrence following LR.

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The Clinical Impact of Solid and Micropapillary Patterns in Resected Lung Adenocarcinoma: Author's Reply

Cited by 4 publications

References 4 publications

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

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

A retrospective study of the relationship between the pathologic subtype and lymph node metastasis of lung adenocarcinomas of ≤3 cm diameter

Spread Through Air Spaces (STAS) in Non−Small Cell Lung Carcinoma

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