Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Thorac Cancer. 2022 Dec;13(23):3310-3321. doi: 10.1111/1759-7714.14687. Epub 2022 Nov 7.
The prognosis of invasive mucinous adenocarcinoma (IMA) remains controversial and should be clarified by comparison with the International Association for the Study of Lung Cancer (IASLC) histologic grading system for invasive nonmucinous adenocarcinoma (INMA).
This study included patients with IMA who underwent curative resection. Their clinicopathological outcomes were compared with those of patients with INMA. Propensity score matching was performed to compare the prognosis of IMA with IASLC grade 2 or 3. Kaplan-Meier survival curves and log-rank tests were used to analyze recurrence-free survival (RFS) and overall survival (OS).
The prognoses of IMA and IASLC grade 2 were similar in terms of RFS and OS. Although patients with IMA had better RFS than patients with IASLC grade 3, the OS was not significantly different. After propensity score matching, IMA demonstrated similar RFS to IASLC grade 2 but superior to IASLC grade 3; there was no difference in the OS compared with grades 2/3. Multivariate analysis revealed that tumor size (hazard ratio [HR] = 1.20, p = 0.028), lymphovascular invasion (HR = 127.5, p = 0.003), and maximum standardized uptake value (HR = 1.24, p = 0.005) were poor prognostic predictors for RFS. Patients with IMA demonstrated RFS similar to and significantly better than that of patients with IASLC grades 2 and 3, respectively. For OS, IMA prognosis was between that of IASLC grades 2 and 3.
Since the prognosis of IMA among lung adenocarcinomas appears to be relatively worse, further clinical studies investigating IMA-specific treatment and follow-up plans are necessary to draw more inferences.
浸润性黏液腺癌（IMA）的预后仍存在争议，需要通过与国际肺癌研究协会（IASLC）用于浸润性非黏液性腺癌（INMA）的组织学分级系统进行比较来明确。
本研究纳入了接受根治性切除术的 IMA 患者，比较了他们的临床病理结局，并与 INMA 患者进行了比较。采用倾向评分匹配比较 IMA 与 IASLC 2 级或 3 级的预后。使用 Kaplan-Meier 生存曲线和对数秩检验分析无复发生存率（RFS）和总生存率（OS）。
IMA 与 IASLC 2 级的 RFS 和 OS 预后相似。虽然 IMA 患者的 RFS 优于 IASLC 3 级患者，但 OS 无显著差异。经过倾向评分匹配后，IMA 的 RFS 与 IASLC 2 级相似，但优于 IASLC 3 级；与 2/3 级相比，OS 无差异。多因素分析显示，肿瘤大小（风险比[HR]＝1.20，p＝0.028）、脉管侵犯（HR＝127.5，p＝0.003）和最大标准化摄取值（HR＝1.24，p＝0.005）是 RFS 的不良预后预测因素。IMA 患者的 RFS 与 IASLC 2 级患者相似，明显优于 IASLC 3 级患者。对于 OS，IMA 的预后介于 IASLC 2 级和 3 级之间。
由于肺腺癌中 IMA 的预后似乎相对较差，因此有必要进行进一步的临床研究，以制定针对 IMA 的特定治疗和随访计划，从而得出更多结论。
