Abstract
The aim of the study is to demonstrate the relationship between clinicopathological variables and organ sites of metastasis in resected lung adenocarcinoma. The clinicopathological characteristics of 748 patients of resected lung adenocarcinoma at Taipei Veterans General Hospital between 2004 and 2012 were retrospectively reviewed. The prognostic value of clinicopathological variables for specific organ site metastasis-free survival was demonstrated. Among the 182 patients with distant metastasis, 93 (51.1%) patients developed contralateral lung metastasis, 81 (44.5%) had brain metastasis, 71 (39.0%) had bone metastasis, and 18 (8.9%) had liver metastasis during follow-up. Acinar predominant (Hazard ratio [HR], 0.468; 95% confidence interval [CI]: 0.250 to 0.877; P = 0.018) was significantly associated with less contralateral lung metastasis in multivariate analysis. Micropapillary predominant (HR, 2.686; 95% CI, 1.270 to 5.683; P = 0.010) was significantly associated with brain metastasis. Acinar predominant (HR, 0.461; 95% CI, 0.216 to 0.986; P = 0.046) was a significant prognostic factor for better contralateral lung metastasis-free survival in multivariate analysis. Micropapillary predominant (HR, 2.186; 95% CI, 1.148 to 4.163; P = 0.017) and solid predominant (HR, 4.093; 95% CI, 1.340 to 12.504; P = 0.013) were significant prognostic factors for worse brain metastasis-free survival and liver metastasis free-survival, respectively. There are significant differences in metastatic behavior between predominant pathological subtypes of lung adenocarcinoma. This information is important for patient follow-up strategy and identification of organ-specific distant metastasis. Prospective multi-institutional studies are mandatory for further validation.
Highlights
Lung cancer is the main cause of cancer-related death worldwide [1]
This study demonstrated that pathological subtypes of lung adenocarcinoma are associated with organ-specific metastasis in patients of resected lung adenocarcinoma with distant metastasis
The new classification of lung adenocarcinoma proposed by IASLC/American Thoracic Society (ATS)/ERS in 2011 was a significant prognostic factor for survival and recurrence in lung adenocarcinoma [18,19,20,21]
Summary
Surgical resection is the treatment of choice for early-stage non-small cell lung cancer (NSCLC) [2]. Tumor recurrence after surgical resection is the most common cause of treatment failure [3,4,5]. Solid tumors have great variation in patterns of metastatic organ tropism [7, 8]. Many reports have demonstrated various predictors for organ-specific metastasis from solid tumors in the literature [9,10,11]. Association between breast cancer molecular subtypes and distinct pattern of metastasis has been reported [12,13,14]. The lung, brain and bone are the most common organ sites of metastasis in resected NSCLC [3,4,5, 15, 16]. In 2011, the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European www.impactjournals.com/oncotarget
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