The clinicopathologic characteristics and tumor immune microenvironment of pulmonary enteric adenocarcinoma

Pulmonary enteric adenocarcinoma (PEAC) as a rare subtype of lung adenocarcinoma is sparsely reported. Currently, to achieve effective treatment and accurate prognosis prediction, the exploration of molecular markers is ongoing.

This study retrospectively enrolled 10 patients with PEAC confirmed by pathology at Zhejiang Cancer Hospital from April 2015 to July 2021. The investigation focused on their clinicopathological features and the tumor immune microenvironment. The expression of LAG-3, PD-L1, and MMR proteins was determined by immunohistochemistry in 7 patients with adequate tissue. Simultaneously, the levels and distribution of CD3, CD8A, CD45RO and PanCK in PEAC patients were measured by multiple immunohistochemical methods to explore and analyze the classification of TIME.

A total of 10 patient pathologically diagnosed as PEAC, the mean age at diagnosis is 60.3 years, and 60% of them were male. The median follow-up for PFS subjects was 16.7 months (95%CI: 4.92-28.48 months). The median OS was 93.9 months (95% CI: 0-216.03 months). All the 7 patients in this study exhibited microsatellite stability (MSS), and PD-L1 expression was negative. Of the 7 patients, only one expressed LAG-3. The analysis of TIME in PEAC patients suggested 'cold tumors', meaning these patients may not benefit from immunotherapy.

PEAC is a rare histological variant of LAUD that occurs predominantly in middle-aged and elderly males. Its morphological characteristics are similar to colorectal adenocarcinoma, and the NaspinA, TTF-1, CK7, CDX2 and CK20 are beneficial for diagnosis. In this study, PEAC patients showed low CD8⁺ T cell, CD45RO⁺ T cell and LAG-3 expression, and negative PD-L1 expression. And all patients were MMS.