Micropapillary and solid subtypes of invasive lung adenocarcinoma: Clinical predictors of histopathology and outcome

Jae, Min; Lee, Ho Yun; Lee, Kyung Soo; Jeong, Ji Yun; Han, Joungho; Shim, Young Mog; Hwang, Hye Sun

doi:10.1016/j.jtcvs.2013.09.045

Cited by 158 publications

(151 citation statements)

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“…Lepidic predominant subtype is known to result in better prognosis compared to other histologic subtypes (2). In contrast, micropapillary and solid predominant subtypes are known to result in poorer prognosis (7)(8)(9)(10). However, the reason for these differences remains unclear (4,11).…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies showed that the invasive adenocarcinoma subtypes were significantly associated with recurrence and survival (3,4,6). Micropapillary and solid predominant subtypes are known to be poorer prognostic (7)(8)(9)(10); however, the reason for this remains unclear (4,11). The most valuable prognostic factor in non-small cell lung cancer is the pathological stage (6).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Park¹,

Kim²,

Moon³

et al. 2017

J. Thorac. Dis.

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Park¹,

Kim²,

Moon³

et al. 2017

J. Thorac. Dis.

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“…Histologically, this group consists of tumor cells that grow in papillary tufts lacking fibrovascular cores, in contrast to true papillary structures which contain fibrovascular cores. Numerous studies have highlighted the poor prognosis of this histologic pattern in lung carcinoma (13,14,22,(31)(32)(33)(34)(35)(36). As stated previously, studies have shown that solid and micropapillary predominant tumors have the worst prognosis among the histologic subtypes.…”

Section: Issues With Current Histologic Classification Systemmentioning

confidence: 78%

“…Additional evidence suggests that the micropapillary pattern may in and of itself be a robust predictor of both prognosis and survival (14,20) and associated with poor outcomes (21,37). Furthermore, it has recently been suggested that the presence or absence of the micropapillary pattern may be an important prognostic indicator and impact survival (32)(33)(34). Rather than use the 5% increment as suggested by the IASLC classification, studies demonstrated that a micropapillary pattern of >1% of the tumor, resulted in metastasis and worse prognosis when compared to patients with no evidence of this histologic subtype (31).…”

Section: Issues With Current Histologic Classification Systemmentioning

confidence: 99%

Surgical pathology of early stage non-small cell lung carcinoma

2016

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While limited resection appears to be suitable for tumors with a ground glass radiographic appearance, which typically correspond to adenocarcinoma in situ (MIS) or minimally invasive adenocarcinoma (MIA) histologically, the role of sublobar resection in radiographic solid tumors is not as clear, and the impact of histologic subtypes with a poor prognosis needs further evaluation. Squamous cell carcinoma (SCC) has not been as extensively studied and the current classification lacks subclassification with significant prognostic information.

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“…Several studies have demonstrated that resected lung adenocarcinomas with micropapillary-predominant pattern show increased recurrence and mortality rates (2,3,(12)(13)(14). Moreover, even very small fractions of micropapillary pattern (1%, 5%, and 10%) have been associated with poor patient outcomes in multiple series (15)(16)(17). It has been hypothesized that these small fractions of micropapillary pattern may represent the micropapillary subtype of STAS (7).…”

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confidence: 99%

Taking the measure of lung adenocarcinoma: towards a quantitative approach to tumor spread through air spaces (STAS)

Morales-Oyarvide

Mino‐Kenudson

2017

J. Thorac. Dis.

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on Cancer; MIA, minimally invasive adenocarcinoma; RFS, recurrence-free survival; CIR, cumulative incidence of recurrence; OS, overall survival; DFS, disease-free survival; CEA, carcinoembryonic antigen; SUV, standardized uptake value; PET, positron emission tomography; CT, computed tomography. 2758Morales-Oyarvide and Mino-Kenudson. Towards a quantitative approach to tumor spread through air spaces (STAS)© Journal of Thoracic Disease. All rights reserved. J Thorac Dis 2017;9(9):2756-2761 jtd.amegroups.com had high STAS. Higher amounts of STAS were associated with pleural invasion (P<0.001), lymphovascular invasion (P<0.001), and tumor size ≥10 mm (P=0.037). The quantity of STAS was also associated with predominant histologic pattern. While solid-predominant pattern was found in 16% of tumors with high STAS, it was seen only in 8% and 2% of those with low and no STAS, respectively (P<0.001). Conversely, lepidic-predominant pattern was observed in only 3% of tumors with high STAS, and in 16% of both low and no STAS tumors (P<0.001). Notably, the authors did not report on the relationship between STAS and the micropapillary-predominant histologic pattern.Importantly, high amounts of STAS were associated with higher risk of recurrence and mortality compared to no STAS. After adjusting for presence of lymphovascular invasion and the predominant histologic pattern, patients with high STAS had a hazard ratio (HR) for RFS of 7.34 (95% CI: 1.54-35.17) compared to patients with no STAS, and this difference was statistically significant. When compared to patients with low STAS, those with high STAS had higher risk of recurrence but this had limited statistical significance (HR for RFS 4.45, Interestingly, nearly all patients with high STAS underwent lobectomy (95%), compared with 79% and 69% of patients with low and no STAS, respectively (P<0.001). Thus, the authors performed secondary analyses stratified by the type of resection. In patients who underwent lobectomy, high STAS was associated with worse RFS (median 140.4, 150.4, and 116.3 months for patients with no-, low-, and high STAS, respectively, P<0.001). Among patients who underwent limited resection, there was a strong trend towards worse RFS in those with high STAS (median 152.9, 117.5, and 85.8 months for patients with no-, low-, and high STAS, respectively, P=0.084) but it did not reach statistical significance, possibly due to the small number of patients in the limited resection group (n=45).In summary, the study by Uruga et al. confirms the previous findings that presence of STAS is associated with adverse pathological features such as lymphovascular invasion and solid-predominant histologic pattern of invasion. The novel and most important finding of this study is the prognostic relevance of the amount of STAS in a tumor, beyond its mere presence or absence. The results clearly demonstrated that high amounts of STAS (defined as 5 or more clusters/single tumor cells) were associated with poor RFS and OS compared to no STAS. Whether high amounts of STAS are a...

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Micropapillary and solid subtypes of invasive lung adenocarcinoma: Clinical predictors of histopathology and outcome

Abstract: Micropapillary and solid subtypes are common in tumors greater than stage I, with size ≥2.5 cm, pure solid type, and maximal standardized uptake value of ≥7, which were predictors for poor DFS. The presence of the micropapillary subtype was a single prognostic factor for OS.

Cited by 158 publications

References 17 publications

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

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

Surgical pathology of early stage non-small cell lung carcinoma

Taking the measure of lung adenocarcinoma: towards a quantitative approach to tumor spread through air spaces (STAS)

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