Niedermaier Benedikt, Allgäuer Michael, Muley Thomas, Schneider Marc A, Eichhorn Martin E, Winter Hauke, Klotz Laura V
Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
Thorac Cancer. 2025 Jan;16(1):e15536. doi: 10.1111/1759-7714.15536.
Among the different subtypes of invasive lung adenocarcinoma, lepidic predominant adenocarcinoma (LPA) has been recognized as the lowest-risk subtype with good prognosis. The aim of this study is to provide insight into the heterogeneity within LPA tumors and to better understand the influence of other sub-histologies on survival outcome.
Overall, 75 consecutive patients with LPA in pathologic stage I (TNM 8th edition) who underwent resection between 2010 and 2022 were included into this retrospective, single center analysis. The proportions of different growth patterns were reported in 5% increments according to the WHO classification.
All tumors exhibited a predominantly lepidic growth pattern (median proportion 70%, IQR 60%-85%). The invasive component included acinar (n = 66, 88%), papillary (n = 41, 55%), micropapillary (n = 14, 19%), and solid growth patterns (n = 4, 5%), with most tumors exhibiting more than one invasive growth pattern. The presence of high-risk growth, that is, micropapillary and solid, was associated with higher T stage (r = 0.423, p = 0.0002). A classification of patients as lepidic/high-risk or lepidic/low-risk based on the presence of micropapillary and solid growth patterns resulted in a significantly worse disease-free survival (p = 0.0169, 5-year DFS: lepidic/high-risk 73% vs. lepidic/low-risk: 95%) for the lepidic/high-risk group, while the groups did not differ in age, gender, smoking status, or extent of resection.
Patients with stage I LPA exhibit considerable intratumor heterogeneity regarding growth patterns, which can be used for prognostic stratification. The occurrence of micropapillary and solid growth patterns in LPA is associated with poorer disease-free survival.
在浸润性肺腺癌的不同亚型中，以鳞屑样生长为主的腺癌（LPA）被认为是风险最低、预后良好的亚型。本研究旨在深入了解LPA肿瘤内部的异质性，并更好地理解其他亚组织学对生存结果的影响。
总体而言，本回顾性单中心分析纳入了2010年至2022年间接受手术切除的75例病理I期（TNM第8版）LPA连续患者。根据WHO分类，以5%的增量报告不同生长模式的比例。
所有肿瘤均表现为以鳞屑样生长为主的模式（中位比例70%，四分位间距60%-85%）。浸润成分包括腺泡状（n = 66，88%）、乳头状（n = 41，55%）、微乳头状（n = 14，19%）和实体生长模式（n = 4，5%），大多数肿瘤表现出不止一种浸润性生长模式。高风险生长模式（即微乳头状和实体状）的存在与更高的T分期相关（r = 0.423，p = 0.0002）。根据微乳头状和实体生长模式的存在将患者分为鳞屑样/高风险或鳞屑样/低风险，结果显示鳞屑样/高风险组的无病生存率显著更差（p = 0.0169，5年无病生存率：鳞屑样/高风险组为73%，鳞屑样/低风险组为95%），而两组在年龄、性别、吸烟状态或切除范围方面无差异。
I期LPA患者在生长模式方面表现出相当大的肿瘤内异质性，可用于预后分层。LPA中微乳头状和实体生长模式的出现与较差的无病生存率相关。
