Analysis of the clinicopathological characteristics, genetic phenotypes, and prognostic of pure mucinous adenocarcinoma

Chen, Zhencong; Li, Ming; Ma, Ke; Shang, Guanning; Liang, Jiaqi; Yin, Jiacheng; Luo, Jizhuang; Zhan, Cheng; Shi, Yu; Wang, Qun

doi:10.1002/cam4.2726

Cited by 9 publications

(14 citation statements)

References 34 publications

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“…Although comprehensive mutational analyses in IMA tumors are limited because of their rarity in lung ADC, molecular characteristics are significantly different from those observed in non-IMA-type ADC. Our data showed predominant mutations in KRAS codon 12 glycine (43%) and rare EGFR mutations (4%), which is consistent with the results of published studies in Asian populations [5,32]. Previous studies have demonstrated that KRAS mutations can be detected in approximately 70% of IMAs that carry different types of substituted mutations at glycine 12 in Western populations [3,6,33] and had concurrent mutations in 35% of KRAS mutation-positive IMAs, including STK11, GNAS, TP53, CDKN2A, and PIK3CA [6].…”

Section: Discussionsupporting

confidence: 93%

Clinicopathological Features and Survival Outcomes of Primary Pulmonary Invasive Mucinous Adenocarcinoma

Gow

Hsieh

Liu

et al. 2021

Cancers

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Pulmonary invasive mucinous adenocarcinoma (IMA) has unique histological patterns. This study aimed to comprehensively evaluate the clinicopathological features, prognosis, and survival outcomes of IMAs. We retrospectively identified 77 patients with pulmonary IMA and reviewed their clinical and pathological features. Another 520 patients with non-IMA-type ADC were retrieved for comparison with patients with IMA. A new two-tier grading system (high-grade and low-grade IMAs) modified from the pancreatic intraepithelial neoplasia classification system was used for survival analyses. Compared to patients with non-IMA-type ADC, patients with IMA tended to have never smoked (p = 0.01) and had early-stage IMA at initial diagnosis (p < 0.001). For stage I–II diseases, the five-year overall survival (OS) rates were 76% in IMAs and 50% in non-IMA-type ADCs, and a longer OS was observed in patients with IMA (p = 0.002). KRAS mutations were the most commonly detected driver mutations, which occurred in 12 of the 28 (43%) patients. High-grade IMAs were associated with a shorter recurrence-free survival (RFS) for stage I–IIIA diseases (p = 0.010) than low-grade IMAs but not for OS. In conclusion, patients with stage I and II IMA had better OS than those with non-IMA-type ADC. A new two-tier grading system might be useful for predicting RFS in stage I–IIIA IMAs.

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Section: Discussionsupporting

confidence: 93%

Clinicopathological Features and Survival Outcomes of Primary Pulmonary Invasive Mucinous Adenocarcinoma

Gow

Hsieh

Liu

et al. 2021

Cancers

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“…The most common primary site of LIMA was the lower lobe. LIMA patients tended to be less advanced in the SEER database and validation cohort, consistent with previous results (10)(11)(12). Given that there were some differences between pure LIMA and mixed LIMA, we conducted a subgroup analysis of OS.…”

Section: Discussionsupporting

confidence: 82%

“…We identified differentiation grade, extent of surgery, and lymphadenectomy as independent predictors for overall survival, in addition to the risk factors of age, sex, and T, N, and M stages. Previous studies indicated that several of these variables were risk factors related to survival in patients with LIMA (10,24). In this study, female patients have a better survival than male patients, which may be related to the more populations of stage I in female patients.…”

Section: Discussionmentioning

confidence: 48%

“…A few nomograms have been developed to predict the prognosis of patients with mucinous adenocarcinoma. Chen et al developed a prognostic nomogram for LIMA with a C-index of 0.724 (10). However, all LIMA patients were enrolled, including the advanced stage patients diagnosed with a transbronchial biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the prognosis of LIMAs remains controversial. Some studies reported that LIMAs might not be aggressive tumors, and the overall survival (OS) was significantly better than nonmucinous adenocarcinoma (10)(11)(12). Other reports showed conflicting results (5,13,14), suggesting that these entities tend to be very heterogeneous.…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of a nomogram for predicting survival in patients with surgically resected lung invasive mucinous adenocarcinoma

Zhang¹,

Wang²,

Jia³

et al. 2021

Transl Lung Cancer Res

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Background: Lung invasive mucinous adenocarcinoma (LIMA) is a unique and rare subtype of lung adenocarcinoma. We identified prognostic factors and developed a nomogram for predicting overall survival (OS) in LIMA patients after surgery. Methods: Patients diagnosed with LIMA between 2008 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database were randomized into training (n=1,254) and test (n=538) cohorts. A nomogram was established using the prognostic signature from the training cohort after multivariable Cox regression analysis. We externally validated the nomogram in a group of 369 patients from China.We separately tested for accuracy and clinical practicability using Harrell's concordance-index (C-index), calibration plots, and decision curve analysis (DCA).Results: We included 2,161 patients in the analysis. Seven factors, all of which significantly affected OS, were incorporated into the final model, including age, sex, differentiation grade, the extent of surgery, lymphadenectomy, and T, N, and M stage. C-indexes for the training, test, and external validation cohorts were 0.735, 0.736, and 0.773, respectively. The areas under the time-dependent receiver operating characteristic curves at five years were 0.747, 0.798, and 0.777, respectively. The nomogram was discriminative and well-calibrated when applied to the test and external validation cohorts. Significant between-group differences in OS were observed when classifying groups by nomogram score (log-rank P<0.001). An online web server for clinical use was developed using the nomogram. Conclusions:The nomogram facilitates accurate prediction of survival for patients with LIMA and can be used to stratify clinical risk groups for individualized treatment.

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Comparison of treatment strategies for resectable locally advanced primary mucinous adenocarcinoma of the lung

Zhu

Deng

et al. 2023

Cancer Medicine

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Background Primary pure mucinous adenocarcinoma (PMA) is a rare type of lung cancer with unique clinical and prognostic features. Previous studies have shown that PMA have more early‐stage cancer compared with other adenocarcinoma (ADC) subtypes. The clinicopathological features and optimal treatment strategies of resectable locally advanced mucinous adenocarcinoma lack evidence and require further study. Methods In this study, we collected information from patients with stage III‐N2 PMA who underwent radical surgery between 2004 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database. The clinicopathological parameters, treatments, overall survival (OS), and cancer‐specific survival (CSS) were evaluated. Results Of 242,699 eligible lung adenocarcinoma patients, 124 with PMA and 3405 with other ADCs of stage III‐N2 received radical surgery were identified. Compared with other ADCs, PMA tended to appear more in the lower lobes, with higher degree of differentiation, less early T stage, and more positive lymph nodes numbers. Patients with PMA had significantly worse survival than other ADCs (OS = 45.0 vs. 57.1 months, p = 0.005, CSS = 51.8 vs. 65.5 months, p = 0.017). We explored the benefit population of postoperative radiotherapy (PORT) and found that the population with ≤7 positive lymph nodes could benefit from PORT, and OS was significantly improved (41.2 vs. 69.3 months, p = 0.034). For patients with >7 positive lymph nodes, PORT did not provide a survival benefit, while chemotherapy improved OS (10.9 vs. 23.3 months, p = 0.041). Multivariate analysis showed that race, tumor location, number of positive lymph nodes, and PORT were independent prognostic factors in patients with postoperative III‐N2 lung PMA. Conclusion The prognosis of patients with resectable III‐N2 primary lung PMA was significantly worse than that of other ADCs, and PORT was an independent prognostic factor. Patients with ≤7 positive lymph nodes could benefit from PORT and those with >7 positive lymph nodes could benefit from chemotherapy.

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Analysis of the clinicopathological characteristics, genetic phenotypes, and prognostic of pure mucinous adenocarcinoma

Cited by 9 publications

References 34 publications

Clinicopathological Features and Survival Outcomes of Primary Pulmonary Invasive Mucinous Adenocarcinoma

Clinicopathological Features and Survival Outcomes of Primary Pulmonary Invasive Mucinous Adenocarcinoma

Development and validation of a nomogram for predicting survival in patients with surgically resected lung invasive mucinous adenocarcinoma

Comparison of treatment strategies for resectable locally advanced primary mucinous adenocarcinoma of the lung

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