Impact of resectable lung adenocarcinoma pathological subtypes on patients prognosis and surgical strategies determination: A SEER population-based data analysis.

Abstract

e20035 Background: The prognosis difference among lung adenocarcinoma patients with different pathological subtypes remains controversial. Furthermore, the appropriate surgical plan according to each subtype for early-staged adenocarcinoma patients is undetermined. Methods: We retrospectively analyzed patients with solid, papillary and acinar lung carcinoma from 2004 to 2015 using SEER*Stat 8.3.4. The primary readout of this study were overall survival (OS). The Kaplan–Meier method was used to determine OS. Results: 2282 patients with lung adenocarcinoma were finally included (solid, N = 117, papillary, N = 739, acinar, N = 1426). For patients received radical resection (lobectomy/bilobectomy, radical and extended pneumonectomy), those with acinar adenocarcinoma had the best survival (median OS: solid, 59 months, papillary, 91 months, acinar,102 months, solid VS papillary, P = 0.258, solid VS acinar, P = 0.014, papillary VS acinar, P = 0.008). For early diagnosed patients in stage I, those with acinar adenocarcinoma who received radical resection had a better OS compared to those received partial resection (wedge resection and segmentectomy) (median OS: wed&seg, 88 months, radical 106 months, P = 0.024). Particularly, patients underwent radical resection or segmentectomy had a better OS compared to those received wedge resection (mean OS of seg: 99.175±5.336 months; median OS: wed, 67 months, radical, 106 months, wed VS radical, P = 0.001, wed VS seg P = 0.026, seg VS radical, P = 0.353), while those treated with radical resection had comparable prognosis compared with patients with segmentectomy. As for patients with stage I papillary adenocarcinoma, those who received partial resection tended to have a worse prognosis compared to those who received lobectomy, although no significant difference was detected (median OS: wed&seg, 74 months, radical 111 months, P = 0.151. N of patients: wed, N = 72, seg, N = 20, radical, N = 415). Conclusions: Patients with acinar lung adenocarcinoma have a better prognosis than solid and papillary adenocarcinoma patients after radical resection. For patients with stage I acinar adenocarcinoma, segmentectomy and radical resection have similar therapeutic effects. For patients with stage I papillary adenocarcinoma, radical resection is the first option.