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Micropapillary Predominance Is a Risk Factor for Brain Metastasis in Resected Lung Adenocarcinoma
Takao Shigenobu1, Yusuke Takahashi2, Yohei Masugi3
1Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
Background:
Histologic subtyping offers some prognostic value in lung adenocarcinoma. We thus hypothesized that histologic subtypes may be useful for risk stratification of brain metastasis (BM). In this study, we aimed to investigate the impact of histologic subtypes on the risk for BM in patients with resected lung adenocarcinoma.
Patients And Methods:
Of 1099 consecutive patients who had undergone curative-intent surgery (2000-2014), 448 patients who had undergone complete resection for lung adenocarcinoma were included in this study. Correlated clinical variables and BM-free survival were analyzed.
Results:
Micropapillary predominance was significantly associated with higher risk of BM after complete resection in univariate analyses (P < .001). In addition, multivariate analyses showed that micropapillary predominance was an independent risk factor for BM (hazard ratio = 2.727; 95% confidence interval, 1.260-5.900; P = .011), along with younger age and advanced pathologic stage. Unlike the other subtypes, an increase in the percentage of the micropapillary subtype was positively correlated with an increase in BM frequency. Patients with micropapillary adenocarcinoma showed significantly poorer brain metastasis-free survival compared with those with non-micropapillary adenocarcinoma (3 years, 78.2% vs. 95.6%; 5 years, 67.3% vs. 94.3%; P < .001).
Conclusion:
The current study demonstrated a significant correlation between micropapillary subtype and higher risk of BM in patients with resected lung adenocarcinoma. This routine histologic evaluation of resected adenocarcinoma may provide useful information for the clinician when considering postoperative management in patients with lung adenocarcinoma. Histologic subtyping offer some prognostic value in lung adenocarcinoma. Because brain metastasis is critical and often refractory to systemic chemotherapy, early detection is clinically important to achieve effective local treatment. We retrospectively analyzed the association between histologic subtypes and occurrence of brain metastasis and found a significant association between micropapillary predominance and higher risk for brain metastasis. Our findings may be relevant when considering postoperative management.
Insights
Histologic subtypes of lung adenocarcinoma impact brain metastasis risk. Micropapillary predominance is an independent risk factor for brain metastasis, necessitating consideration in postoperative management.
Area of Science:
- Oncology
- Pathology
Background:
- Histologic subtyping in lung adenocarcinoma offers prognostic value.
- Brain metastasis (BM) is a critical concern in lung adenocarcinoma management.
- Risk stratification for BM is essential for effective patient care.
Purpose of the Study:
- To investigate the impact of histologic subtypes on the risk of brain metastasis in patients with resected lung adenocarcinoma.
- To determine if histologic subtyping can aid in risk stratification for brain metastasis.
Main Methods:
- Retrospective analysis of 448 patients with completely resected lung adenocarcinoma.
- Correlation of clinical variables and brain metastasis-free survival.
- Univariate and multivariate analyses to identify risk factors for BM.
Main Results:
- Micropapillary predominance was significantly associated with a higher risk of BM (HR=2.727, P=.011).
- Increased micropapillary subtype percentage positively correlated with BM frequency.
- Patients with micropapillary adenocarcinoma had significantly poorer BM-free survival.
Conclusions:
- Micropapillary subtype is an independent risk factor for BM in resected lung adenocarcinoma.
- Histologic subtyping, specifically identifying micropapillary predominance, can inform postoperative management decisions.
- Early detection of BM risk through histologic evaluation is clinically important.
