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Updated: Oct 1, 2025
Author Spotlight: Advancing Early Detection and Treatment of Gastrointestinal Tumors
Published on: February 16, 2024
The presence of lepidic and micropapillary/solid pathological patterns as minor components has prognostic value in
Yucheng Hou1, Weijian Song1, Mingzhi Chen2
1Department of Thoracic Surgery, Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Background:
The acinar- and papillary-predominant histological subtypes are the most common types of invasive lung adenocarcinoma and are considered "intermediate-grade" carcinomas with heterogeneous prognosis. This study investigated the prognostic significance of the lepidic and micropapillary/solid pathological patterns as minor components in patients with intermediate-grade lung adenocarcinomas.
Methods:
A total of 697 patients with pathological N0M0 acinar/papillary-predominant lung adenocarcinomas ≤3 cm in diameter, who underwent curative resection in our institution between June 1, 2014 and August 31, 2016, were retrospectively enrolled in this study. Acinar/papillary-predominant lung adenocarcinomas were classified into four subtypes according to the presence of the minor pathological components lepidic (Lep), micropapillary (MP), and solid (S). The subtypes were MP/S-Lep+, MP/S-Lep-, MP/S+Lep+, and MP/S+Lep-. The 5-year recurrence-free survival (RFS) and overall survival (OS) were recorded. Factors affecting survival were analyzed by Cox regression method.
Results:
Among 697 intermediate-grade lung adenocarcinomas, the distribution of patients was as follows: MP/S-Lep+ type (n=314; 45.0%), MP/S-Lep- type (n=144; 20.7%), MP/S+Lep+ type (n=133; 19.1%), and MP/S+Lep- type (n=106; 15.2%). The 5-year RFS rates were 98.7%, 94.4%, 94.0%, and 81.9%, respectively (P<0.001). The 5-year OS rates were 98.4%, 94.4%, 96.6%, and 87.7%, respectively (P<0.001). Multivariate analysis revealed that the MP/S+Lep- subtype was an independent poor prognostic factor of both RFS and OS.
Conclusions:
Acinar/papillary-predominant adenocarcinoma is an "intermediate-grade" carcinoma that can be further classified into subtypes according to the presence of lepidic and micropapillary/solid pathological patterns with significantly different prognosis. This classification may be useful in evaluating the recurrence risk and guiding adjuvant therapies in patients with acinar/papillary-predominant stage I lung adenocarcinoma.
