Virtual Library
Start Your Search
Luigi Ventura
Author of
-
+
P08 - Early Stage/Localized Disease - Epidemiology (ID 117)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P08.01 - Prognostic Impact of Second Predominant Pattern in Lung Adenocarcinoma: Analysis From a Large Multicentric European Database (ID 1564)
00:00 - 00:00 | Author(s): Luigi Ventura
- Abstract
Introduction
According to the ATS/ERS/IASLC classification, adenocarcinoma patterns could be divided in three groups based on their clinical and pathological behaviors: low- (lepidic), intermediate- (papillary or acinar) and high-grade (micropapillary and solid). Different patterns might have a significant impact on clinical outcomes. In this study, in a moderate grade predominant patient cohort, we have analyzed the impact of second predominant pattern and other possible prognostic factors on DFS.
Methods
We retrospectively collected data of stage I and II lung adenocarcinoma operated on between January 2014 and December 2017 in nine European thoracic surgery departments. All patients with intermediate-grade predominant patterns who underwent anatomical resection with lymphadenectomy for adenocarcinoma and pathological N0 were included in the study. Patients with pure adenocarcinoma or those composed by more than two subtypes and mucinous pattern were excluded. Recurrence rate and factors affecting DFS were analyzed according to the second predominant pattern.
Results
270 were selected for this study. There were 149 males (55%) and mean age was 68.3 years (±SD 8.5). The most commonly performed lung resection was lobectomy (225, 83.3%).
Second predominant pattern was present as follows: lepidic 116 (43.0%), papillary 62 (23.0%), solid 39 (14.4%), acinar 32 (11.9%) and micropapillary 21 (7.8%). Recurrence rate was 21.5% (58 patients) and overall DFS was 54.6 months (95% IC 51.6-57.6). Patients with a high grade second predominant pattern had a decreased DFS compared to low and moderate grade second predominant pattern, but the difference was not statistically significant (p=0.275).
We performed a subgroup analysis of 60 patients with a high grade second predominant pattern. 39 (65%) patients had solid pattern, while 21 (35%) had micropapillary pattern and they did not differ in terms of DFS. At univariable analysis, percentage of second predominant pattern, age and tumor diameter were significantly related to DFS (p=0.024, p=0.009 and p=0.024 respectively). Other variables such as differentiation grade, lymphovascular invasion and pleural invasion did not show any significant impact. At multivariable analysis, larger tumor size (p=0.051 HR 1.034 95% CI 1.000-1.070) and age (p=0.049; HR 1.073 95% CI 1.000-1.150) confirmed their prognostic role; concurrently, the percentage of second predominant high-grade pattern increased its significance (p=0.016 HR 1.048 95% CI 1.009-1.089)
Conversely, in the subgroup of 116 patients with lepidic second predominant pattern, pleural invasion (p=0.030) and tumor diameter (p=0.001) significantly influenced DFS at univariable analysis. Although the difference was not statistically significant, there was a tendency to improved DFS in patients who presented > 20% of lepidic pattern (56.8 vs 48.4 months, p=0.521). Multivariable analysis confirmed the prognostic role of tumor dimension (p=0.023, OR: 1.037, 95% CI: 1.005-1.070) in this subgroup of patients.
Conclusion
In our large multicentric cohort of early stage N0 lung adenocarcinoma with an acinar or papillary predominant pattern, the impact of second predominant pattern on DFS is not homogeneous: the most significant impact can be found in patients with solid or micropapillary predominant patterns directly proportional to their percentage.
-
+
P38 - Pathology - Pathology/Staging (ID 108)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P38.10 - Relationship Between the Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Lung Adenocarcinoma Patterns: A Single-Center Experience (ID 2463)
00:00 - 00:00 | Presenting Author(s): Luigi Ventura
- Abstract
Introduction
DLCO is an indicator of lung damage. The aim of this study was to find a relationship between DLCO and the histopathological patterns of lung adenocarcinoma (ADK).
Methods
One-hundred and ninety-three patients with low DLCO (<80% of predicted) and 267 patients with normal DLCO (>80% of predicted) who underwent radical surgery for lung ADK between 2001 and 2018 were retrospectively reviewed. The relationships between DLCO status and ADK patterns as well as the overall survival were evaluated.
Results
DLCO was significantly related to smoking habitude, FEV1, lymphoid infiltrate, tumor grade and ADK histopathological patterns (Table 1). The lepidic predominant pattern was mostly found in patients with normal DLCO; the solid pattern in patients with low DLCO (p-value:0.013). The DLCO value was significantly higher in low-grade ADK, progressively decreasing in the intermediate and high-grade ADK (p-value:0.024; Table 2). Multivariable logistic regression analysis confirmed a significant correlation between DLCO and ADK patterns; low DLCO remained significantly related to high-grade ADK (OR:1.63, 95%CI:1.11-2.43; p-value:0.015). Considering the well-known association between non-smokers and the development of well-differentiated ADK, to eliminate this influence we confirmed the relationship between DLCO and histopathological ADK patterns taking into account only the 377 former and current smokers (p-value:0.021). At univariate analysis, sex, histopathological ADK patterns, tumor grade and stage, pleural invasion, tumor necrosis, tumor desmoplasia, FEV1 and DLCO were significantly related to the overall survival. Multivariate analysis revealed that only sex, tumor stage and tumor necrosis were significantly related with the overall survival (odds ratios: 0.480, 2.63 and 1.7; 95% CI: 0.31-0.72; 1.70-4.06 and 1.11-2.58; p-value: 0.001, 0.001 and 0.014, respectively).
Table 1 - Clinicopathological characteristics classified by the DLCO status
Low DLCO
(n=193)
Normal DLCO
(n=267)
p-value
Age, years (mean +/- SD)
65,7 +/- 7,9
68 +/- 8,8
0,198
Gender
0,555
Male
120 (62,2%)
174 (65,2%)
Female
73 (37,8%)
93 (34,8%)
Smoking status
<0,001
Never
17 (8,8%)
49 (18,4%)
Former
34 (17,6%)
88 (33,0%)
Current
130 (67,4%)
125 (46,8%)
Unknown
12 (6,2%)
5 (1,9%)
FEV1.0
0,003
< 80%
72 (37,0%)
64 (23,7%)
=> 80%
121 (63,0%)
203 (76,3%)
Tumor location
0,340
RUL
86 (44,6%)
104 (39,1%)
RML
8 (4,1%)
13 (4,9%)
RLL
21 (10,9%)
26 (9,8%)
LUL
44 (22,8%)
59 (22,2%)
LLL
22 (11,4%)
51 (19,2%)
Right hilum
8 (4,1%)
6 (2,3%)
Left hilum
4 (2,1%)
7 (2,6%)
Surgical procedure
0,865
Wedge resection
10 (5,2%)
18 (6,8%)
Segmentectomy
3 (1,6%)
3 (1,1%)
Lobectomy
169 (87,6%)
233 (87,3%)
Bilobectomy/Pneumonectomy
11 (5,7%)
13 (4,9%)
Histological subtypes
0,013
Lepidic
16 (8,3%)
46 (17,2%)
Acinar
45 (23,3%)
72 (27,0%)
Papillary
27 (14,0%)
46 (17,2%)
Micropapillary
17 (8,8%)
17 (6,4%)
Solid
88 (45,6%)
86 (32,2%)
Grade
0,007
1
11 (5,7%)
33 (12,4%)
2
42 (21,8%)
75 (28,2%)
3
140 (72,5%)
158 (59,4%)
Stage
0,738
1
117 (60,6%)
161 (60,3%)
2
41 (21,2%)
51 (19,1%)
3+4
35 (18,1%)
55 (20,6%)
Lymphoid infiltrate
0,002
Low
111 (72,5%)
157 (83,5%)
High
42 (27,5%)
31 (16,5%)
Pleural invasion
0,320
0
115 (59,6%)
176 (66,2%)
1
44 (22,8%)
51 (19,2%)
2
19 (9,8%)
27 (10,2%)
3
15 (7,8%)
13 (4,5%)
Lymphatic invasion
0,394
Absent
96 (49,7%)
144 (54,1%)
Present
97 (50,3%)
122 (45,9%)
Vascular invasion
0,905
Absent
122 (74,4%)
148 (73,3%)
Present
42 (25,6%)
54 (26,7%)
Necrosis
0,397
Absent
80 (58,8%)
99 (64,3%)
Present
56 (41,2%)
55 (35,7%)
Table 2
ConclusionADK histologic pattern
DLCO value (%, mean +/- SD)
p-value: 0.024
Lepidic
92,8 ± 17,3
Acinar
89,9 ± 25,2
Papillary
88,1 ± 20,2
Micropapillary
79,9 ± 19,5
Solid
80,6 ± 22,4
In this study, we found a relationship between DLCO and ADK patterns, suggesting that lung damage might be associated with tumor aggressiveness.
