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Early-stage lung adenocarcinomas with a micropapillary pattern, a distinct pathologic marker for a significantly poor
Tatsu Miyoshi1, Yukitoshi Satoh, Sakae Okumura
1Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Abstract:
Adenocarcinomas with a micropapillary pattern (MPP), featuring small papillary tufts lacking a central fibrovascular core, are thought to have a poor prognosis. To examine whether the MPP is a predictor of prognosis, clinicopathologic characteristics of adenocarcinomas were analyzed with particular reference to survival of early-stage patients. The subjects were 344 consecutive patients (female/male ratio 163:181) for whom complete surgical resection was undertaken at the Cancer Institute Hospital, Japan, during 1986-1995. Histologically, they were divided into two groups: MPP-positive (n = 139; 40%) and MPP-negative (n = 205; 60%). The following items were significantly more frequent in the MPP-positive group: metastasis to lymph nodes (p <0.001), pleural invasion (p = 0.02), intrapulmonary metastasis (p <0.001), and nonsmoking status (p = 0.002). In stage I patients (i.e., without lymph node metastasis, n = 154), 5-year survival of the MPP-positive group (n = 45) was 79%, significantly lower than the MPP-negative group (n = 109) of 93% (p = 0.004). In many cases of the c-stage I MPP-positive group, upstaging was necessary on the basis of pathologic findings for metastases, and the survival was between stage I and stage II. Our study clearly indicated that the MPP is a distinct prognostic marker for lung adenocarcinoma, particularly regarding apparent stage I diseases.
Insights
Micropapillary pattern (MPP) in lung adenocarcinoma indicates a poorer prognosis, even in early stages. This finding helps identify high-risk patients for better treatment strategies.
Area of Science:
- Oncology
- Pathology
- Surgical Oncology
Background:
- Adenocarcinomas with a micropapillary pattern (MPP) are characterized by small papillary structures without a central fibrovascular core.
- MPP is suspected to be associated with a poor prognosis in lung adenocarcinoma.
- Early-stage lung cancer patients require accurate prognostic markers for optimal management.
Purpose of the Study:
- To determine if the micropapillary pattern (MPP) is a significant predictor of prognosis in lung adenocarcinoma.
- To analyze clinicopathologic characteristics and survival rates in relation to MPP in early-stage lung adenocarcinoma patients.
Main Methods:
- Retrospective analysis of 344 lung adenocarcinoma patients who underwent complete surgical resection.
- Patients were classified into MPP-positive (n=139) and MPP-negative (n=205) groups based on histological examination.
- Clinicopathologic features and survival data were compared between the two groups, with a focus on stage I patients.
Main Results:
- MPP-positive group showed significantly higher rates of lymph node metastasis, pleural invasion, and intrapulmonary metastasis.
- Five-year survival for stage I MPP-positive patients (79%) was significantly lower than for MPP-negative patients (93%).
- Pathologic review often led to upstaging of apparent stage I MPP-positive cases, with survival rates between stage I and II.
Conclusions:
- The micropapillary pattern (MPP) is a distinct prognostic marker for lung adenocarcinoma.
- MPP is particularly important for predicting outcomes in patients with apparently early-stage disease.
- Identification of MPP can aid in risk stratification and inform treatment decisions for lung adenocarcinoma.