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early-stage pulmonary adenocarcinoma (T1N0M0 and Stage I)

Tuesday 19 August 2014


The proposed IASLC/ATS/ERS classification of lung adenocarcinoma identifies histological categories with prognostic differences that may be helpful in identifying candidates for adjunctive therapy. (#21252858#)

In a study (#21252858#), three overall prognostic groups were identified:
- low grade: adenocarcinoma in situ (n=1) and minimally invasive adenocarcinoma (n=8) had 100% 5-year disease-free survival;
- intermediate grade: non-mucinous lepidic predominant (n=29), papillary predominant (n=143) and acinar predominant (n=232) with 90, 83 and 84% 5-year disease-free survival, respectively;
- high grade: invasive mucinous adenocarcinoma (n=13), colloid predominant (n=9), solid predominant (n=67) and micropapillary predominant (n=12), with 75, 71, 70 and 67%, 5-year disease-free survival, respectively (P<0.001).

Among the clinicopathological factors, stage 1B versus 1A (P<0.001), male sex (P<0.008), high histological grade (P<0.001), vascular invasion (P=0.002) and necrosis (P<0.001) were poorer prognostic factors on univariate analysis. (#21252858#)

Both gross tumor size (P=0.04) and invasive tumor size adjusted by the percentage of lepidic growth (P<0.001) were significantly associated with disease-free survival with a slightly stronger association for the latter. (#21252858#)

The slightly stronger association with survival for invasive size versus gross size raises the need for further studies to determine whether this adjustment in measuring tumor size could impact TNM staging for small adenocarcinomas. (#21252858#)

However, in a study (#23542459#), none of the clinical parameters of a patient population (type of surgery, age, gender, tumor size, and comorbidities) showed any statistically significant correlation with outcome, except for associated malignancies, which not surprisingly appeared to have a negative impact on survival. Statistical analyses of the histological characteristics to include tumor differentiation and the percentage of a lepidic or bronchioloalveolar component did not show any statistically significant values in terms of survival. (#23542459#) These results failed to show any statistically significant difference of survival between those T1N0M0 adenocarcinomas with a lepidic component and those without, thus questioning the use of terms such as "in situ" or "minimally invasive adenocarcinoma". (#23542459#) For these authors, the outcome for patients with T1N0M0 disease is still best determined by appopriate staging rather than by changes in the pathology nomenclature of adenocarcinoma. (#23542459#)

Open references

- Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience. Weissferdt A, Kalhor N, Marom EM, Benveniste MF, Godoy MC, Correa AM, Swisher SG, Moran CA. Mod Pathol. 2013 Aug;26(8):1065-75. doi:10.1038/modpathol.2013.33 . PMID: #23542459# [Free]

- Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Yoshizawa A, Motoi N, Riely GJ, Sima CS, Gerald WL, Kris MG, Park BJ, Rusch VW, Travis WD. Mod Pathol. 2011 May;24(5):653-64. doi:10.1038/modpathol.2010.232 . PMID: #21252858#"