Lymph node involvement according to lung adenocarcinoma subtypes: lymph node involvement is influenced by lung adenocarcinoma subtypes

Abstract

Backgrounds: Invasive adenocarcinoma subtypes are known to be associated with prognosis; however, the underlying reason remains unclear. To find out the reason, we investigated the possible influence of lymph node (LN) involvement by the constituent histologic subtypes in the tumor and clarified the different prognosis according to the predominant histologic subtypes in the tumor and LN.Methods: A total of 97 consecutive patients who underwent surgical resection for lung invasive adenocarcinoma between February 2009 and December 2015 were included. We analyzed the associations of the histologic subtypes between the tumor and LN and disease-free survival (DFS) according to the histologic subtypes and predicted the histologic subtype in LN involvement using the component ratio of the predominant histologic subtype in the tumor. A P value <0.05 was considered statistically significant.Results: Acinar and papillary subtypes occupied the majority of the predominant histological subtypes (tumor 73.2%, LN 71.1%). The tumor showed significantly more constituent histologic subtypes than LN (P<0.001). Micropapillary and solid predominant subtype were more common in poorer differentiation (tumor P<0.001, LN P=0.001). The predominant histologic subtype in the tumor was not the same as that in LN and micropapillary and solid predominant subtypes were significantly more prone to LN involvement than other subtypes (P<0.001). Regarding the predominant histologic subtypes in the tumor, there was no significant difference in DFS between micropapillary and solid predominant subtypes and other subtypes.However, regarding the predominant histologic subtypes in LN, micropapillary and solid predominant subtypes had significantly lower DFS than other subtypes (P=0.010). Solid predominant subtype had a significant cutoff value for prediction of the predominant histologic subtype in LN using the component ratio of the predominant histologic subtype in the tumor (cutoff value 12.5%, sensitivity 70.0%, specificity 82.4%, area 0.775, P<0.001).Conclusions: The present study presented a possible reason of discrepancies in outcomes according to the lung adenocarcinoma constituent subtypes. Micropapillary and solid predominant subtypes had poorer prognosis than other subtypes, which might be explained by being more prone to LN involvement.

The characteristics and nomogram for primary lung papillary adenocarcinoma

“…The majority of additional studies concluded that in invasive ADC, patients with lepidic predominant adenocarcinoma (LPA) were endowed with the best survival, followed by acinar predominant adenocarcinoma (APA) and papillary predominant adenocarcinoma (PPA), while patients with solid predominant adenocarcinoma (SPA) and mucin production adenocarcinoma (MPA) showed the worst survival rates [8,[10][11][12][13]. Our present study found 36.0% of patients were in the condition of TNM IV and pathological characteristics exerted a remarkable effect in determining OS of pulmonary PA patients, which was similar to additional studies [14]. Worse pathological differentiation degree of tumor cell is prominently correlated with unsatisfactory clinical outcome [2].…”

“…Specifically, in this cohort, pulmonary PA subjects with poor pathological differentiation had merely a mean OS of 21.1 months while patients with well pathologically differentiated tumor had significant longer 30.6 months. Besides, another one of the valuable prognostic factors in primary pulmonary PA was lymph node involvement [14]. Ikuo et al revealed the higher occult nodal metastasis rate in PPA subtype (17/154, 11.0%) and SPA subtype (2/7, 28.6%) (both P=0.001) in comparison with additional subtypes through retrospectively analyzing 237 patients with peripheral clinical stage I lung adenocarcinoma [15].…”

Cost-Sensitive Uncertainty Hypergraph Learning for Identification of Lymph Node Involvement With CT Imaging

“…Patients without metastatic lymph nodes, or with only intrapulmonary or hilar lymph nodes, are generally considered candidates for straightforward resection. Although the sub-types of LUAD are found related to the predictors of LN metastasis, they are available postoperatively ( 10 ). Information of the preoperative LN metastasis is valuable for the adequacy of surgical resection and the decision of the adjuvant therapy ( 11 ).…”

Prognostic impact according to the proportion of the lepidic subtype in stage IA acinar‐predominant lung adenocarcinoma

“…It is well known that the micropapillary (MPP) and solid‐predominant histological subtypes have worse prognoses than the other subtypes, although curative resection and mediastinal lymph node dissection are carried out in stage I lung adenocarcinoma. 5 , 6 In contrast, lepidic‐predominant subtype indicates good prognosis. 7 However, the most common of the predominant subtypes are acinar lung adenocarcinoma and the incidence rate of the MPP or solid‐predominant subtype is lower in early lung adenocarcinoma.…”