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High-grade histological patterns in metastatic lymph nodes associated with poor prognosis in resected lung
Huiyan Deng1, Shaonan Xie2, Yueping Liu1
1Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Abstract:
We aimed to investigate the prognostic value of high-grade patterns (HGPs) in lymph node metastasis in lung adenocarcinoma (LUAD). We retrospectively analysed patients (n=345; 2016-2018) with pathological stage IIB-IIIB LUAD who underwent lobectomy. We evaluated the overall survival (OS) and recurrence-free survival (RFS) of patients with and without a micropapillary/solid pattern in the primary tumour and lymph node metastases. Among the patients, the median age was 61.0 years, 54.2% (n=187) were female and 36.5% (n=126) had a history of smoking. Among the involved lymph nodes, 70.4% (n=243) were in pN2 stage and 29.6% (n=102) were in pN1 stage. Of the patients, 32.8% (n=113) had only one lymph node metastasis at the N2 station, whereas 37.7% (n=130) had multiple lymph node metastases at the N2 station. Patients with vascular invasion (p=0.003), pN2 stage (p<0.001), and a predominantly solid histological pattern in the primary tumour (p<0.001) were more likely to have metastatic lymph nodes of the solid subtype. Using a cut-off value of 10% rather than 20%, HGPs were more significant in evaluating RFS (p<0.001 vs p=0.22) and OS (p=0.009 vs p=0.46). Compared to patients without HGPs in lymph node metastases, the presence of a solid component [hazard ratio (HR) 2.07, 95% confidence interval (CI) 1.27-3.38; p=0.004], micropapillary component (HR 3.20, 95% CI 1.81-5.68; p<0.001), and both solid and micropapillary components (HR 2.60, 95% CI 1.54-4.40; p<0.001) in lymph node metastasis were all significantly associated with poorer OS. Patients with only micropapillary components (HR 1.96, 95% CI 1.19-3.22; p=0.008) or both micropapillary and solid components (HR 1.75, 95% CI 1.12-2.71; p=0.013) in lymph node metastasis had significantly poorer RFS. For surgically resected LUAD patients with lymph node metastasis, those with high-grade histological patterns in metastatic lymph nodes had a poorer prognosis, and the histological patterns of metastatic lymph nodes can be used to stratify such patients.
