Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Clinical Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Ann Surg Oncol. 2024 Jan;31(1):167-177. doi: 10.1245/s10434-023-14193-w. Epub 2023 Nov 5.
Primary lung mucinous adenocarcinomas (LMAs) could be subclassified as the pure-solid, part-solid, and pneumonic types according to the findings of high-resolution computed tomography. This study aimed to expound on the clinicopathologic, radiologic, and prognostic characteristics of LMAs based on radiologic classification within a large set of patients.
From November 2009 to December 2016, this study enrolled 294 resected LMAs, which were divided into the pure-solid (n = 169), part-solid (n = 87), and pneumonic (n = 38) types. The clinicopathologic and radiologic characteristics of the tumors were evaluated, and patient prognosis was determined through follow-up evaluation. Survival outcomes were calculated by Kaplan-Meier curves and compared using log-rank tests. The prognostic impact of clinicopathologic variables, including radiologic presentations, were evaluated by establishing a Cox proportional hazards model.
The LMAs were infrequently associated with lymph node metastasis (5.4 %), lymphatic/vascular invasion (4.4 %), or visceral pleural invasion (5.1 %). During the median 71-month follow-up period, recurrence was observed in 62 patients and death in 44 patients. The patients with pneumonic-type LMAs had a poorer prognosis (5-year recurrence-free survival [RFS], 23.7 %; 5-year overall survival [OS], 44.7 %) than those with the pure-solid type (RFS, 83.2 %; OS, 100 %) or part-solid type (RFS, 93.7 %; OS, 100 %). Besides, lymph node metastasis, emphysema, and clinical T stage were independent predictors of RFS and OS.
Solitary-type LMA patients had excellent prognoses, whereas the survival outcomes for pneumonic-type LMA patients were dismal. Furthermore, pneumonic-type LMA patients were prone to intrapulmonary metastasis by means of aerogenous dissemination rather than distant metastasis.
根据高分辨率计算机断层扫描的结果，原发性肺黏液腺癌（LMAs）可细分为纯实性、部分实性和肺炎型。本研究旨在阐述基于影像学分类的大量患者中 LMAs 的临床病理、影像学和预后特征。
本研究纳入了 2009 年 11 月至 2016 年 12 月期间切除的 294 例 LMAs，分为纯实性（n = 169）、部分实性（n = 87）和肺炎型（n = 38）。评估肿瘤的临床病理和影像学特征，并通过随访评估患者的预后。生存结果通过 Kaplan-Meier 曲线计算，并通过对数秩检验进行比较。通过建立 Cox 比例风险模型评估包括影像学表现在内的临床病理变量的预后影响。
LMAs 淋巴结转移（5.4%）、淋巴管/血管侵犯（4.4%）或内脏胸膜侵犯（5.1%）的发生率较低。在中位 71 个月的随访期间，62 例患者出现复发，44 例患者死亡。肺炎型 LMA 患者的预后较差（5 年无复发生存率 [RFS]，23.7%；5 年总生存率 [OS]，44.7%），低于纯实性型（RFS，83.2%；OS，100%）或部分实性型（RFS，93.7%；OS，100%）。此外，淋巴结转移、肺气肿和临床 T 分期是 RFS 和 OS 的独立预测因素。
孤立型 LMA 患者的预后良好，而肺炎型 LMA 患者的生存结果较差。此外，肺炎型 LMA 患者更容易通过空气传播发生肺内转移，而不是远处转移。
