期刊
GENERAL THORACIC AND CARDIOVASCULAR SURGERY
卷 65, 期 5, 页码 273-279出版社
SPRINGER JAPAN KK
DOI: 10.1007/s11748-017-0747-3
关键词
Tomography, X-ray Computed; Lung Neoplasms; Pathology, Surgical
资金
- Japan Surgical Society [Young Researcher Award]
- Grants-in-Aid for Scientific Research [15K10252] Funding Source: KAKEN
Objective This study examined the clinical and radiological characteristics of adenocarcinoma having the micropapillary histological subtype. Methods We included 233 patients who were operated from 2001 to 2012 for lung adenocarcinoma of 2 cm or less. The pathology was reviewed according to the 2015 WHO classification. We defined adenocarcinoma with a micropapillary component as adenocarcinoma in which the area of the micropapillary histological subtype exceeded 5% of the tumor. The difference in cumulative incidence of recurrence (CIR) in the presence of death as a competing risk between two groups was assessed using the methods of Gray. Results Twenty-one cases (9.0%) had a micropapillary component. The micropapillary component was associated with a higher frequency of lymphatic invasion (28.6 vs. 7.5% in adenocarcinoma without a micropapillary component; P = 0.008) and vascular invasion (38.1 vs. 15.1%, P = 0.014) and lymph node metastasis (31.3 vs. 5.2%, P = 0.003). The median follow-up period was 6.5 years. CIR at 5 years was 23.8% [95% confidence interval (CI), 8.3-43.7%] for adenocarcinoma with a micropapillary component, and 11.4% (95% CI, 7.4-16.2%) for adenocarcinoma without a micropapillary component (P = 0.033). Adenocarcinoma with a micropapillary component was more frequent in solid nodules (17.8%, 16/90) on high-resolution computed tomography (HRCT) than in either ground-glass nodules (1.5%, 1/67) or part-solid nodules (5.3%, 4/76) (P = 0.001). The HRCT finding was the only preoperative factor that was associated with a micropapillary component in the multivariate analysis. Conclusions The micropapillary component in adenocarcinoma should be regarded as indicative of a high-grade malignancy and was associated with the HRCT finding.
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