The percentage of lepidic growth is an independent prognostic factor in invasive adenocarcinoma of the lung
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RESEARCH
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The percentage of lepidic growth is an independent prognostic factor in invasive adenocarcinoma of the lung Trond-Eirik Strand1*, Hans Rostad1, Erik H. Strøm2 and Philip Hasleton3,4
Abstract Background: The literature is inconclusive as to whether the percentage of the lepidic component of an invasive adenocarcinoma (AC) of the lung influences prognosis. We studied a population-based series of selected, resected invasive pulmonary ACs to determine if incremental increases in the lepidic component were an independent, prognostic variable. Methods: Patients undergoing resection for lung cancer reported to the Cancer Registry of Norway and diagnosed in the period 1993-2002 with a bronchioloalveolar carcinoma (BAC) (old terminology) (adenocarcinoma in situ, AIS in the new terminology) in the lung were selected. A pulmonary pathologist reviewed all sections and estimated the percentage of the lepidic component. Follow-up of survival was to the end of 2013. Results: One hundred thirty-one patients were identified, 102 had AC with lepidic growth. Of these, 44 had AC with a component of lepidic growth less than 50 % and seven had AC with 95 % lepidic component or more. One of the latter cases was considered to be AIS. In regression analyses, superior survival was associated with a greater lepidic component (p = 0.041). Mucinous tumors had a worse prognosis than non-mucinous (p = 0.012) in regression analyses, as did increasing age and stage. The five-year observed survival was 69.0 % for non-mucinous cases and 66.7 % for the group with a lepidic component of 80 % or greater. Conclusion: The percentage of the lepidic component appears to be an independent, significant prognostic factor in a selection of pulmonary AC. Keywords: Adenocarcinoma in situ (AIS), Lepidic growth, Prognosis, Population-based survival, Lepidic predominant adenocarcinoma (LPA) Bronchioloalveolar carcinoma (BAC)
Background New concepts were introduced in the 2011 classification of lung adenocarcinomas (ACs) by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society [1]. One was the lepidic-predominant adenocarcinoma (LPA) for diagnoses based on resections. This property was first noted by Noguchi in 1995 [2] and has later been found to indicate a favorable prognosis [3] and with 5-year disease free survival of 94 % [4]. When LPA was introduced in the 2011 classification, histologic subtyping to assess the different patterns semi* Correspondence: [email protected] 1 Department of Registration, Cancer Registry of Norway, Oslo, Norway Full list of author information is available at the end of the article
quantitatively in 5 % increments and describing a single predominant pattern for the diagnosis were suggested. The recording of the percentage of a tumor component was classified in the paper as ‘a weak recommendation’ with ‘low-quality evidence, ’ probably because of the lack of research on this topic. The association between the percentage of lepidic component and pr
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