Characteristics and Prognostic Nomogram for Primary Lung Lepidic Adenocarcinoma

Area of Science:

• Pulmonary Medicine
• Oncology
• Pathology

Background:

• Lepidic predominant adenocarcinoma (LPA) is an uncommon subtype of invasive pulmonary adenocarcinoma (ADC).
• Limited data exists on the specific clinicopathological characteristics and prognostic indicators for LPA.
• Understanding these factors is crucial for accurate diagnosis and treatment planning.

Purpose of the Study:

• To investigate the clinicopathological features of LPA.
• To identify independent prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in LPA patients.
• To develop and validate nomograms for predicting long-term survival in LPA.

Main Methods:

• Retrospective analysis of 4191 LPA patients from the SEER database.
• Comparison of LPA cases with non-LPA pulmonary ADC.
• Application of univariate and multivariate Cox proportional hazard models.
• Validation of nomograms using concordance index, ROC curves, calibration plots, and decision curve analysis.

Main Results:

• LPA patients were typically older females with smaller tumors, less pleural invasion, and lower histological grade and stage compared to non-LPA ADC.
• Age, sex, race, tumor location, tumor size, pleural invasion, histological grade, stage, primary tumor surgery, and chemotherapy were independent survival predictors.
• Developed nomograms demonstrated good accuracy and superior prognostic capacity compared to the TNM staging system.

Conclusions:

• Lepidic predominant adenocarcinoma is more prevalent in elderly women and characterized by smaller tumor size and lower grade, suggesting a potentially favorable prognosis.
• The developed nomograms provide accurate predictions for long-term survival in LPA patients.
• These findings enhance the understanding and management of this rare lung adenocarcinoma subtype.