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Salvatore Bellafiore



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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-29 - Impact of Second Predominant Pattern on Recurrence in Early Stage Resected Lung Adenocarcinoma: A Multicentric Study (Now Available) (ID 2515)

      10:15 - 18:15  |  Author(s): Salvatore Bellafiore

      • Abstract
      • Slides

      Background

      The ATS/ERS/IASLC adenocarcinoma classification allowed not only a better anatomical-pathological definition, but it showed a significant influence on long-term outcomes. It has been proposed that adenocarcinoma patterns could be divided in three groups according to their clinical and pathological behaviors: low (lepidic), moderate (papillary or acinar) and high grade (micropapillary and solid). Moreover, different patterns might mingle influencing biological features and prognosis. We focused on resected adenocarcinomas analyzing the impact of second predominant pattern on recurrence rate and Disease-Free Survival (DFS).

      Method

      We retrospectively collected all stage I and II lung adenocarcinoma operated on between January 2014 and December 2017 in seven European thoracic surgery departments. We selected all patients who underwent an anatomical resection with lymphadenectomy; patients with incomplete follow up, pure adenocarcinoma or those composed by more than two subtypes (if third pattern accounted for more than 10%) were excluded. Mucinous adenocarcinoma were considered separately from other patterns. DFS, incidence and localization of recurrence were calculated according to the second predominant pattern.

      Result

      Among 500 patients, 331 were selected. There were 186 male, mean age was 68.1 years (±SD 8.2) and 105 (31.7%) patients were active smokers at the moment of diagnosis. The majority of patients (271, 81.9%) underwent a lobectomy. Low, medium and high-grade first predominant pattern were 45 (13.6%), 208 (62.9%), 57 (17,2%) respectively and 21 cases were mucinous.

      Second predominant pattern was present as follow: acinar 96 (29%), lepidic 86 (26%), papillary 74 (22.4%), solid 29 (8.8%), micropapillary 26 (7.9%), 20 mucinous (6%). DFS analysis showed a significant impact of grade of the second predominant pattern (p=0.046), while first predominant pattern’s grade did not significantly impact on DFS (p=0.322). According to the subtypes of second predominant pattern, lepidic pattern showed a better mean DFS (56.1 versus 49.6 months, p=0.014) and a lower recurrence rate (p=0.018, and, in particular, a lower distant recurrence rate, p=0.016), while micropapillary had a worse DFS (42.3 versus 52.1 months, p=0014), higher recurrence rate (p=0.017, and in particular, a higher regional recurrence, p=0.038); moreover, also pleural invasion influenced DFS significantly (p=0.001). At multivariate analysis, lepidic second pattern and pleural invasion confirmed their influence on DFS (p=0.044, IC 0.28-0.98 and p=0.001, IC 1.36-3.4).

      When we analyzed the subgroup with only moderate grade (acinar and papillary) first predominant pattern (208 patients), lepidic and micropapillary second predominant patterns and pleural invasion confirmed their significant impact on DFS (p=0.015; p=0.021; 0.015 respectively).

      Conclusion

      Our multicentric study confirms the impact of adenocarcinoma patterns on recurrence rate and DFS. The second predominant pattern in early stage resected adenocarcinoma seems to play an important role in influencing the outcomes. Micropapillary and lepidic second pattern demonstrated to be significantly related to recurrence development and their presence should require different and dedicated postoperative management.

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