Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Oncology, The First Clinical Medical College of Henan University, Kaifeng, China.
World J Surg Oncol. 2024 Sep 5;22(1):235. doi: 10.1186/s12957-024-03429-y.
Micropapillary (MPP) adenocarcinoma is considered one of the most aggressive pathological types of lung adenocarcinoma (LADC). This retrospective study aimed to evaluate the prognostic significance and benefit of postoperative adjuvant therapy (PAT) in stage IA LADC patients with different proportions of MPP components.
We retrospectively examined clinical stage IA LADC patients who underwent surgical resection between August 2012 and December 2019. In terms of the proportion of MPP components (TPM), the tumors were reclassified into three categories: MPP patterns absent (TPMN); low proportions of MPP components (TPML); and high proportions of MPP components (TPMH). The dates of recurrence and metastasis were identified based on physical examinations and were confirmed by histopathological examination.
Overall, 505 (TPMN, n = 375; TPML, n = 92; TPMH, n = 38) patients harboring EGFR mutations were enrolled in the study. Male sex (P = 0.044), high pathological stage (P < 0.001), and MPP pathological subtype (P < 0.001) were more frequent in the TPM-positive (TPMP) group than in the TPM-negative (TPMN) group. Five-year disease-free survival (DFS) rates were significantly lower in the TPMP group than in the TPMN group (84.5% vs. 93.4%, P = 0.006). In addition, patients with high proportions (greater than 10%) of MPP components had worse overall survival (OS) (91.0% vs. 98.9%, P = 0.025) than those with low proportions (5%≤ TPM ≤ 10%). However, postoperative EGFR tyrosine kinase inhibitors (TKIs) or adjuvant chemotherapy (ACT) cannot improve DFS and OS between EGFR-mutated patients with different proportions of MPP components.
MPP was related to earlier recurrence and shortened survival time, even in stage IA. Further research needs a larger sample size to clarify that EGFR-mutated stage IA patients with MPP components obtain survival benefits from adjuvant therapy.
微乳头状（MPP）腺癌被认为是肺腺癌（LADC）中最具侵袭性的病理类型之一。本回顾性研究旨在评估不同 MPP 成分比例的 IA 期 LADC 患者术后辅助治疗（PAT）的预后意义和获益。
我们回顾性分析了 2012 年 8 月至 2019 年 12 月接受手术切除的临床 IA 期 LADC 患者。根据 MPP 成分的比例（TPM），肿瘤被重新分类为三类：MPP 模式缺失（TPMN）；低比例 MPP 成分（TPML）；高比例 MPP 成分（TPMH）。复发和转移的日期是根据体格检查确定的，并通过组织病理学检查得到证实。
总体而言，共有 505 名（TPMN，n=375；TPML，n=92；TPMH，n=38）携带 EGFR 突变的患者纳入研究。与 TPMN 组相比，TPM 阳性（TPMP）组男性比例更高（P=0.044），病理分期更高（P<0.001），MPP 病理亚型（P<0.001）更为常见。TPMP 组的 5 年无病生存率（DFS）明显低于 TPMN 组（84.5% vs. 93.4%，P=0.006）。此外，高比例（大于 10%）MPP 成分患者的总生存（OS）更差（91.0% vs. 98.9%，P=0.025）。然而，对于不同 MPP 成分比例的 EGFR 突变患者，术后接受 EGFR 酪氨酸激酶抑制剂（TKI）或辅助化疗（ACT）并不能改善 DFS 和 OS。
即使在 IA 期，MPP 也与更早的复发和更短的生存时间相关。需要更大的样本量进一步研究，以明确具有 MPP 成分的 EGFR 突变 IA 期患者是否从辅助治疗中获益。
