Yukihiro Yoshida1, Jun-Ichi Nitadori2, Aya Shinozaki-Ushiku3, Jiro Sato4, Tempei Miyaji5, Takuhiro Yamaguchi5, Masashi Fukayama3, Jun Nakajima2. 1. Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yyoshida-tky@umin.ac.jp. 2. Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 3. Department of Pathology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 4. Department of Radiology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 5. Department of Clinical Trial Data Management, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Abstract
OBJECTIVE: This study examined the clinical and radiological characteristics of adenocarcinoma having the micropapillary histological subtype. METHODS: We included 233 patients who were operated from 2001 to 2012 for lung adenocarcinoma of 2 cm or less. The pathology was reviewed according to the 2015 WHO classification. We defined adenocarcinoma with a micropapillary component as adenocarcinoma in which the area of the micropapillary histological subtype exceeded 5% of the tumor. The difference in cumulative incidence of recurrence (CIR) in the presence of death as a competing risk between two groups was assessed using the methods of Gray. RESULTS: Twenty-one cases (9.0%) had a micropapillary component. The micropapillary component was associated with a higher frequency of lymphatic invasion (28.6 vs. 7.5% in adenocarcinoma without a micropapillary component; P = 0.008) and vascular invasion (38.1 vs. 15.1%, P = 0.014) and lymph node metastasis (31.3 vs. 5.2%, P = 0.003). The median follow-up period was 6.5 years. CIR at 5 years was 23.8% [95% confidence interval (CI), 8.3-43.7%] for adenocarcinoma with a micropapillary component, and 11.4% (95% CI, 7.4-16.2%) for adenocarcinoma without a micropapillary component (P = 0.033). Adenocarcinoma with a micropapillary component was more frequent in solid nodules (17.8%, 16/90) on high-resolution computed tomography (HRCT) than in either ground-glass nodules (1.5%, 1/67) or part-solid nodules (5.3%, 4/76) (P = 0.001). The HRCT finding was the only preoperative factor that was associated with a micropapillary component in the multivariate analysis. CONCLUSIONS: The micropapillary component in adenocarcinoma should be regarded as indicative of a high-grade malignancy and was associated with the HRCT finding.
OBJECTIVE: This study examined the clinical and radiological characteristics of adenocarcinoma having the micropapillary histological subtype. METHODS: We included 233 patients who were operated from 2001 to 2012 for lung adenocarcinoma of 2 cm or less. The pathology was reviewed according to the 2015 WHO classification. We defined adenocarcinoma with a micropapillary component as adenocarcinoma in which the area of the micropapillary histological subtype exceeded 5% of the tumor. The difference in cumulative incidence of recurrence (CIR) in the presence of death as a competing risk between two groups was assessed using the methods of Gray. RESULTS: Twenty-one cases (9.0%) had a micropapillary component. The micropapillary component was associated with a higher frequency of lymphatic invasion (28.6 vs. 7.5% in adenocarcinoma without a micropapillary component; P = 0.008) and vascular invasion (38.1 vs. 15.1%, P = 0.014) and lymph node metastasis (31.3 vs. 5.2%, P = 0.003). The median follow-up period was 6.5 years. CIR at 5 years was 23.8% [95% confidence interval (CI), 8.3-43.7%] for adenocarcinoma with a micropapillary component, and 11.4% (95% CI, 7.4-16.2%) for adenocarcinoma without a micropapillary component (P = 0.033). Adenocarcinoma with a micropapillary component was more frequent in solid nodules (17.8%, 16/90) on high-resolution computed tomography (HRCT) than in either ground-glass nodules (1.5%, 1/67) or part-solid nodules (5.3%, 4/76) (P = 0.001). The HRCT finding was the only preoperative factor that was associated with a micropapillary component in the multivariate analysis. CONCLUSIONS: The micropapillary component in adenocarcinoma should be regarded as indicative of a high-grade malignancy and was associated with the HRCT finding.
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