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Carlo Pomari



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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-31 - Surgically Resected Acinar Adenocarcinoma of the Lung: Analysis of Different Prognostic Groups. (ID 13321)

      16:45 - 18:00  |  Author(s): Carlo Pomari

      • Abstract
      • Slides

      Background

      Adenocarcinoma has become the most frequently diagnosed histotype of Non-Small cell Lung Cancer (NSCLC). Nevertheless, the latest classification of lung adenocarcinoma issued by IASLC/ATS/ERS identified different subtypes with different prognostic impact; concurrently, different subtypes might mingle influencing biological features and behavior. We focused on surgically treated stage I and II predominantly acinar lung adenocarcinoma analyzing outcomes and prognostic factors according to the second main histological pattern.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively collected all lung adenocarcinoma with a predominant acinar histological pattern operated on between October 2012 and September 2017 in our institution. We selected all patients in pathological stage I A-B and II A-B with full preoperative staging procedures performed at our institution. All clinical and pathological features were registered. We analyzed outcomes according to the histological sub pattern and we focused on main prognostic factors.

      4c3880bb027f159e801041b1021e88e8 Result

      During the study period we performed 153 lung resections for patients affected by NSCLC. Among them we found 93 adenocarcinoma and 55 had a predominant acinar pattern. Among selected patients, there were 33 female and the mean age was 68.2 (SDĀ±9.3) years. The histology report showed a solely acinar pattern in 11 cases (20.0%), while a second main sub-pattern was seen in the remaining cases: papillary or micropapillary in 7 cases (12.7%); lepidic in 27 cases (49.1%) and solid in 10 (18.2%). Mean Overall Survival (OS) and Disease-Free Survival (DFS) of all the cohort of patients were 66.1 (CI 95% 59.7-72.4) and 51.9 (CI 95% 42.7-61.2) months respectively. According to the secondary histological pattern, papillary and micropapillary subtypes showed a significant worse OS (p=0.029) and DFS (p=0.015) compared to all the other subtypes; concurrently they showed a significant higher mean Standard Uptake Value of T component at the preoperative PET-CT (11.8 vs 6.4, p=0.007) and had a higher rate of vascular invasion at the specimen (P=0.002). Beyond papillary and micropapillary subtypes, vascular invasion showed to be a significant prognostic factor both for OS and DFS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Lung adenocarcinoma encompasses different sub-histotypes. In our experience, stage I and II resected predominantly acinar adenocarcinoma with papillary or micropapillary component showed higher rate of vascular invasion in the specimen and worse long-term outcomes compared to other subtypes, which might be related with a higher aggressiveness. In conclusion, our results suggest that different postoperative management should be adopted according to adenocarcinoma histological subtypes pattern; histology patterns should also be considered as a prognostic factor to be included in the NSCLC staging system.

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