Abstract
Background
Lepidic adenocarcinoma (LPA) is an infrequent subtype of invasive pulmonary adenocarcinoma (ADC). However, the clinicopathological features and prognostic factors of LPA have not been elucidated. We undertook a retrospective population-based analysis to examine the clinicopathological features of LPA, and construct nomograms predicting long-term survival of LPA patients.
Methods
Data from the Surveillance, Epidemiology, and End Results (SEER) database of 4087 LPA patients diagnosed between 2005 and 2014 were retrospectively analyzed and compared with non-LPA pulmonary ADC to explore the clinicopathological and prognosis features of LPA. All patients included in our study were histologically confirmed. Those with multiple primary tumors in their lifetime, unknown survival data, unknown tumor-node-metastasis (TNM) stage, and unknown information including age, race, and marital status were excluded. Univariate and multivariate Cox proportional hazard models were performed to identify independent survival predictors for further nomogram development. The nomograms were internally and externally validated for concordance index and calibration plots as well as decision curve analysis.
Results
Compared with non-LPA pulmonary ADC patients, those with LPA exhibited unique clinicopathological features, including more elderly and female patients, smaller tumor size, lesser pleural invasion, lower histological grade and stage. Multivariate analyses showed that age, sex, marital status, primary tumor size, pleural invasion, histological grade, stage, primary tumor surgery, and chemotherapy were independently associated with overall survival (OS) and cancer-specific survival (CSS) in patients with LPA, while race was the only independent prognostic factor for OS, not for CSS. The nomograms showed good accuracy comparing with actual observed results and demonstrated improved prognostic capacity than TNM stage.
Conclusions
Patients with LPA are more common in older age and female. The smaller tumor size, lower histological grade and stage are the clinicopathological features of LPA which may indicate a good prognosis. The constructed nomograms accurately predict the long-term survival of LPA patients.
Influence of non-jaundice stage at diagnosis on clinicopathological features and long-term survival of patients with periampullary carcinomas
