Characteristics and nomogram for primary lung lepidic adenocarcinoma

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.Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database of 4087 LPA patients were retrospectively analyzed and compared with non-LPA pulmonary ADC to explore the clinicopathological and prognosis features of LPA. Univariate and multivariate Cox proportional hazard models were performed to identify independent survival predictors for further nomogram development. The nomograms were validated by using the concordance index, receiver operating characteristic curves, and calibration plots, as well as decision curve analysis, in both the training and validation cohorts.Results: Compared with non-LPA pulmonary ADC patients, those with LPA exhibited unique clinicopathological features, including more elderly and female patients, smaller tumor size, less pleural invasion, and 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 compared with the actual observed results and demonstrated improved prognostic capacity compared with TNM stage.Conclusions: Patients with LPA are more likely to be older and female. 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.

Characteristics and Nomogram for Primary Lung Lepidic Adenocarcinoma

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.Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database of 4087 LPA patients were retrospectively analyzed and compared with non-LPA pulmonary ADC to explore the clinicopathological and prognosis features of LPA. Univariate and multivariate Cox proportional hazard models were performed to identify independent survival predictors for further nomogram development. The nomograms were validated by using the concordance index, receiver operating characteristic curves, and calibration plots, as well as decision curve analysis, in both the training and validation cohorts.Results: Compared with non-LPA pulmonary ADC patients, those with LPA exhibited unique clinicopathological features, including more elderly and female patients, smaller tumor size, less pleural invasion, and 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 compared with the actual observed results and demonstrated improved prognostic capacity compared with TNM stage.Conclusions: Patients with LPA are more likely to be older and female. 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.

Dual-Block Elastic Stain Significantly Increasing Visceral Pleural Invasion(VPI) Positivity and Analysis of Potential Predictors of VPI in Peripheral Non-Small Cell Lung Cancer

Background: Visceral pleural invasion (VPI) is a critical component in the staging of peripheral non–small cell lung carcinoma (NSCLC). Single tumor tissue block for elastic stain is conducive to identifying pleural invasion in routine pathologic examination. We aim to investigate whether dual-block elastic stain increase VPI positivity compared with single-block elastic stain, further analyze the potential predictors of VPI status.Methods: Resected 8419 consecutive peripheral NSCLC cases including tumor size≤3cm 6008 patients were retrospectively reviewed. Total cases were divided into a cohort using one tumor tissue paraffin block (single-block group, n=5184) and a cohort using dual tumor tissue paraffin blocks (dual-block group, n=3235) for elastic stain. Each case was performed with Victoria-blue van Gieson staining to assess VPI status. The clinicopathologic features of patients were collected from the electronic medical record system.Results: The overall incidence of VPI was 12.4% (1047/8419) in peripheral NSCLC patients. The VPI positivity detected by dual-block elastic stain was significantly higher than that by single-block elastic stain (17.7% (573/3235) v.s. 9.1% (474/5184), P＜0.001). The presence of VPI in T1 ≤3cm patients detected by single and dual block elastic stain was 6.3% (235/3730) and 12.0% (273/2278), respectively (P＜0.001). Therefore, 5.7% T1 patients (stage IA) are additionally upstaged to T2a (stage IB) by dual block elastic stain. But the incidence of VPI in pT2a patients had no significant difference between single-block group and dual-block group (16.8% vs 17.1%, P=0.916). The lymphovascular invasion, lymph node metastasis, poor differentiated carcinomas and the presence of STAS status could be well significant predictors of VPI (P＜0.001). Area under the ROC curve of adenocarcinoma morphology was 0.263 for lepidic pattern, 0.544 for acinar and papillary pattern, and 0.720 for micropapillary and solid pattern in predicting invasion of pleura.Conclusion: Our results indicated that using dual-block elastic stain identify more VPI positive T1 NSCLC patients who are upstaged to T2a and could benefit from optimal management after post-operation. The application of dual-block elastic stain is an efficient and practical method to detect VPI, especially for patients with high-risk prognostic factors.

Ultra-High-Resolution CT Features of Pulmonary Nodules Correlate with Visceral Pleural Invasion in Early Stage Lung Adenocarcinoma

Backgroundvisceral pleural invasion (VPI) is an important prognostic factor in early stage lung adenocarcinoma, which can affect the TNM Classification of Tumors.PurposeTo investigate whether ultra-high-resolution computed tomography (U-HRCT) features can predict VPI of early stage pulmonary nodules contacting the interlobar pleura.Material and MethodsA total of 126 patients with lung adenocarcinoma (age, 24-77 years) confirmed by surgical pathology were retrospectively enrolled. All patients underwent U-HRCT scan and were divided into two groups according to pulmonary nodular type: pure (pGGN) and mixed (mGGN). Clinical features were recorded, and U-HRCT features were manually measured using PHILIPS EBW V4.5.5. Univariate and multivariate logistic regression were used to determine factors that can significantly predict VPI. ResultsU-HRCT and three-dimensional orthogonal post-processing method could better display the relationship between GGNs and interlobar fissures. Among all patients, fifteen patients (12%) had VPI. None of the patients with pGGN had VPI. In the mGGN group, the solid ratio (odds ratio [OR]=1.275, 95% CI 1.1-1.478; P=0.001) and solid diameter (OR=1.139, 95% CI 1.06-2.346; P=0.046) were independent risk factors for VPI in early stage lung adenocarcinoma. For VPI diagnosis, the area under the curve, sensitivity, and specificity of the solid ratio and solid diameter were 0.803, 80%, and 75% and 0.807, 80%, and 80.36%, respectively.ConclusionU-HRCT can display GGNs and interlobar fissures in detail. VPI was not detected in patients with pGGN. In patients with mGGNs, a solid diameter >6mm and solid ratio >38% can be independent predictors of VPI, which may be helpful in surgical decision-making.