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Pietro Bertoglio



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    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
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      P08.01 - Prognostic Impact of Second Predominant Pattern in Lung Adenocarcinoma: Analysis From a Large Multicentric European Database (ID 1564)

      00:00 - 00:00  |  Presenting Author(s): Pietro Bertoglio

      • Abstract
      • Slides

      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.

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