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Clinical impact of minimal micropapillary pattern in invasive lung adenocarcinoma: prognostic significance and survival outcomes.

浸润性肺腺癌中微乳头结构含量最小值的临床意义:对预后和生存期的影响

Lee G,Lee HY,Jeong JY,Han J,Cha MJ,Lee KS,Kim J,Shim YM

Abstract

Micropapillary subtype has recently been established to be a distinct marker for poor prognosis in lung adenocarcinomas. According to the current classification of lung adenocarcinomas, all subtypes are listed semiquantitatively in 5% increments. In other words, a minimal amount of the micropapillary pattern, precisely <5% of the entire tumor is disregarded. Therefore, we sought to assess the prognostic significance and survival outcomes in patients with a micropapillary pattern proportion of <5% of the entire tumor. A total of 525 patients with lung adenocarcinoma were classified into 3 subgroups according to the presence and proportion of micropapillary subtype: (1) ≥5% of the micropapillary pattern (n=114); (2) <5% of the micropapillary pattern (n=115); and (3) absence (<1%) of the micropapillary pattern (n=296). Sex, TNM stage, lymph node status (N status), tumor size, and predominant subtype demonstrated a significant difference among the 3 subgroups. Overall survival (OS) and disease-free survival (DFS) were significantly different among the 3 subgroups (P=0.009 and 0.001 for OS and DFS, respectively). Furthermore, OS was significantly better in patients without the micropapillary pattern (<1%) than in those with <5% (P=0.034). At multivariate analyses, age (P=0.005) and N status (P=0.005) were independent prognostic factors influencing OS. In conclusion, our results demonstrated that even a small proportion of the micropapillary pattern, specifically <5% of the entire tumor has a significant prognostic impact on OS. N status remained an independent prognostic factor that negatively influenced OS.

摘要

最近已经明确微乳头亚型是肺腺癌预后差的标志。根据最新肺腺癌分类,要半定量注明腺癌各亚型成分,以5%比例递增。换言之,当整个肿瘤内微乳头结构成分为最小值,准确说含量<5%时,不予考虑。因此,我们试图评估微乳头结构占整个肿瘤比例<5%时对肺腺癌患者预后和生存期影响。共研究了525名肺腺癌患者,根据微乳头结构是否存在及其存在比例,将患者分为三组:(1) 微乳头结构≥5%,114例;(2)微乳头结构<5%,115例;(3)微乳头结构缺乏(<1%),296例。三组患者,在性别、TNM分期、淋巴结转移情况(N 转移情况)、肿瘤大小和肺腺癌主要亚型方面具有显著差异。三组间总体生存期(OS)和无病生存期(DFS)也显著不同(OS和DFS的P值分别为0.009和0.001)。而且,缺乏微乳头结构(<1%)的患者OS显著长于微乳头结构<5%的患者(P=0.034)。多变量分析显示, 患者年龄(P=0.005)和淋巴结转移情况(P=0.005)是影响OS的独立预后因素。 因此,我们得出结论: 即使微乳头结构少到占整个肿瘤比例<5%,对OS也有明确显著的预后影响,淋巴结转移是负面影响OS的独立预后因素。
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