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

Di Lu,Hua Wu,Xiguang Liu,Xiaoshun Shi,Kaican Cai,Jianxue Zhai,Zhizhi Wang,Jianjun Yang,Jianjun Jiang,Siyang Feng,Xiaoying Dong,Shijie Mai

doi:10.1002/cam4.3012

Abstract

BackgroundWhether 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.MethodsData 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).Results1531 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). And ACN patients who received Lob had a equivalent LCSS, compared to those who received Seg (P = .895). For patients with PAP in stage I, those who received Lob tended to have a better prognosis than that received Seg (HR of OS, 0.605, 95% CI: 0.263‐1.393; HR of LCSS, 0.541, 95% CI: 0.194‐1.504) or Wed (HR of OS, 0.735, 95% CI: 0.481‐1.123; HR of LCSS, 0.688, 95% CI: 0.402‐1.180).ConclusionsAmong patients with lung adenocarcinoma in stage I, those with ACN have a better OS and LCSS than that with PAP. For patients with stage I ACN, Seg and Lob, rather than Wed, seem to be an equivalent treatment choice; however, Seg is the prior option because it could preserve more lung function than Lob. For patients with PAP, Lob tends to be a better choice than Wed and Seg, although the prognostic difference between them is nonsignificant.

Highlights

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death.[1]
For some specific groups of patients with early-stage Nonsmall cell lung cancer (NSCLC), a few studies showed that limited resection (LR), including segmentectomy (Seg) and wedge resection (Wed), could achieve equivalent survival compared to lob.[6-9]
We found that among patients with lung adenocarcinoma in stage I, those with ACN had a significantly better overall survival (OS) and lung cancer specific survival (LCSS) than patients with papillary predominant adenocarcinoma (PAP)

Summary

| INTRODUCTION

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death.[1]. The difference in prognosis between patients with ACN and those with PAP, remains ambiguous.[12,15,16] Taken together, it seems safe for patients with early-stage lung solid and micropapillary adenocarcinoma to receive lob[17,18] and acceptable for patients with early-stage nonmucinous lepidic adenocarcinoma to receive LR.[19]. To the best of our knowledge, no studies have found the best surgical approach for patients with early-stage ACN and PAP To address these issues of great interest, the Surveillance, Epidemiology, and End Results (SEER) public database was employed, which is a national population-based database and provides both large cohort size and long-term follow-up. The aim of this study was to evaluate the postoperative differences in prognosis between NSCLC patients with ACN and PAP and to determine the best surgical approaches based on the SEER public database

| MATERIALS AND METHODS

| RESULTS

| DISCUSSION

CONFLICT OF INTEREST

Findings

DATA SHARING STATEMENT