Clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma

Abstract

Background: Whether prognosis differs between lung acinar predominant adenocarcinoma (ACN) and papillary predominant adenocarcinoma (PAP) patients remains controversial. Furthermore, the appropriate surgical plan for each subtype is undetermined. Methods: Data of stage I ACN or PAP patients from 2004 to 2015 were retrospectively reviewed by SEER*Stat 8.3.5. The primary outcome was overall survival (OS) and lung cancer specific survival (LCSS). Results: 1531 patients (PAP, 484; ACN, 1047) were included. ACN patients had better OS (P = .001) and LCSS (P = .003) than PAP patients. Among stage I ACN patients, lobectomy with mediastinal lymph node dissection (Lob) (P = .001) or segmentectomy (Seg) (P = .003) provided a better OS than wedge resection (Wed).

Comparison of outcomes following lobectomy, segmentectomy, and wedge resection based on pathological subtyping in patients with pN0 invasive lung adenocarcinoma ≤1 cm

“…Both as the mid‐differentiation adenocarcinoma, we found the difference in prognosis between acinar and papillary predominant subtypes for wedge resection in invasive adenocarcinoma ≤1 cm. Previous reports have also showed the difference in survival with regard to surgical approach between acinar and papillary predominant subtypes in stage I patients 25,27 . Our results might be attributed to the sufficient margins or less lymph node evaluation requirement for the wide wedge resection when the patient is acinar predominant pathological patterns.…”

“…Previous reports have also showed the difference in survival with regard to surgical approach between acinar and papillary predominant subtypes in stage I patients. 25,27 Our results might be attributed to…”

Comment on “clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma”

“…Comment on "clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma" Dear editor, We would like to comment on the recent published article entitled "Clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma." Lu et al 1 performed an interesting study to demonstrate that segmentectomy was equivalent to lobectomy for stage I acinar predominant adenocarcinoma (ACN) while lobectomy remain the optimal procedure for stage I papillary predominant adenocarcinoma (PAP). The study highlighted the importance of decision-making on appropriate surgical procedures according to the histologic subtypes of lung adenocarcinoma.…”

“…4,5 In addition, the SEER program does not release all the data on chemotherapy due to uncertainties regarding data completeness, 6 which indicates that the chemotherapy data might not be reliable enough in Table 1. 1 To sum up, the authors omitted several important issues that might lead to potential bias in their studies, which should be addressed and interpreted with caution.…”

The prognostic impact of lung adenocarcinoma predominance classification relating to pathological factors in lobectomy, the Japanese Joint Committee of Lung Cancer Registry Database in 2010

“…AIS and MIA were reported to show excellent outcome [3]. Other than AIS and MIA, the surgical outcome of invasive adenocarcinoma and variants vary, and the predominant subtype of invasive adenocarcinoma has been reported to be one of the prognostic factors [4][5][6][7][8][9][10][11][12][13][14]. However, these findings were based on a small number of cases from a limited number of facilities lacking uniform surgical procedures, a narrow range of pathological stages, and non-uniform backgrounds.…”