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Invasive features of small-sized lung adenocarcinoma adjoining emphysematous bullae
Gouji Toyokawa1, Mototsugu Shimokawa2, Yuka Kozuma1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
Objectives:
Radiologically small-sized adenocarcinomas are special entities of lung cancer, as their radiological and pathological invasiveness determines the surgical procedures applied; however, the clinicopathological features of small-sized lung adenocarcinoma adjoining cystic airspaces (Ca-ADJ) have yet to be fully clarified. The aim of this study was to elucidate the clinicopathological characteristics, including the programmed death ligand 1 (PD-L1) expression, in patients with Ca-ADJ ≤3.0 cm.
Methods:
A total of 283 patients with resected adenocarcinoma, whose radiological tumour size was ≤3.0 cm without lymph node or distant metastases on preoperative high-resolution computed tomography, were analysed for their clinicopathological and radiological features. Furthermore, the PD-L1 expression was evaluated by immunohistochemistry using an anti-human PD-L1 rabbit monoclonal antibody (clone SP142).
Results:
Among the 283 patients, 31 (11.0%) patients were reported to have Ca-ADJ. The Fisher's exact test demonstrated that Ca-ADJ was significantly associated with male gender (P < 0.001), a history of smoking (P < 0.001), a high consolidation/tumour ratio (P = 0.026), advanced pathological stage (P < 0.001), the presence of pleural (P < 0.001) and vessel invasion (P < 0.001), histological invasive subtypes (P < 0.001) and wild-type epidermal growth factor receptor (P = 0.001). The patients with Ca-ADJ had a significantly higher maximum standardized uptake value than those without Ca-ADJ (8.4 vs 4.1, P < 0.001). Furthermore, Ca-ADJ was significantly associated with the PD-L1 expression (P < 0.001). Log-rank test showed that patients with Ca-ADJ had a significantly shorter disease-free survival than those without Ca-ADJ (P = 0.001).
Conclusions:
This study showed that patients with radiologically small-sized Ca-ADJ might exhibit radiologically and pathologically invasive features.
Insights
Small lung adenocarcinomas adjoining cystic airspaces (Ca-ADJ) are linked to invasive features and poorer survival. These findings highlight the importance of evaluating Ca-ADJ in lung cancer patients for better treatment strategies.
Area of Science:
- Pulmonology
- Oncology
- Pathology
Background:
- Radiologically small-sized lung adenocarcinomas require precise characterization for surgical planning.
- The clinicopathological features of small lung adenocarcinoma adjoining cystic airspaces (Ca-ADJ) remain incompletely understood.
Purpose of the Study:
- To investigate the clinicopathological characteristics of Ca-ADJ ≤3.0 cm.
- To evaluate programmed death ligand 1 (PD-L1) expression in Ca-ADJ.
Main Methods:
- Retrospective analysis of 283 patients with resected lung adenocarcinoma (≤3.0 cm) without nodal or distant metastasis.
- Evaluation of PD-L1 expression using immunohistochemistry (clone SP142).
Main Results:
- Ca-ADJ was identified in 11.0% of patients and significantly associated with male gender, smoking history, high consolidation/tumour ratio, advanced stage, pleural and vessel invasion, invasive subtypes, and wild-type EGFR.
- Ca-ADJ patients exhibited higher maximum standardized uptake values and significantly associated PD-L1 expression.
- Patients with Ca-ADJ had significantly shorter disease-free survival.
Conclusions:
- Radiologically small Ca-ADJ can present with invasive pathological features.
- Ca-ADJ is associated with aggressive clinicopathological characteristics and poorer prognosis.
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