Differences in the prognosis of resected lung adenocarcinoma according to the histological subtype: a retrospective analysis of Japanese lung cancer registry data

OBJECTIVES: This study intended to assess the clinicopathological features of the histological subtypes of adenocarcinoma of the lung in a large registry population. METHODS: The Japanese Joint Committee of Lung Cancer Registry performed a nationwide retrospective registry study on the prognosis and clinicopathological profiles of 11 663 patients who underwent resection for primary lung neoplasm in 2004. The registry data of 7921 (62.5%) patients with adenocarcinoma were analysed regarding the prognosis and clinicopathological features according to the histological subtype of adenocarcinoma. The histological subtypes were defined according to the 1999 World Health Organization classification (third edition), where bronchioloalveolar carcinoma (BAC) is defined as adenocarcinoma with a pure bronchioloalveolar growth pattern without invasion. RESULTS: The distribution of the histological subtype was acinar in 471 patients (7.5%), papillary in 2004 (32.2%), BAC in 1385 (22.3%), solid adenocarcinoma with mucin in 103 (1.7%) and adenocarcinoma with mixed subtypes (AMS) in 2257 (36.3%). The 5-year overall survival rates according to histological subtype were 63.4% for acinar, 72.9% for papillary, 90.3% for BAC, 54.4% for solid adenocarcinoma with mucin and 73.7% for AMS. While the survival rate in patients with BAC was significantly better than those for the other histological subtypes, acinar and solid adenocarcinoma with mucin had significantly worse prognoses than the other histological subtypes. The histological subtype was an independent predictor of survival in a multivariate analysis (P < 0.001). Regarding BAC, the pathological stage included not only Stage IA/IB (n = 1275; 92.1%), but also Stage II-IV (n = 110; 7.9%). One hundred twenty-five patients (9.0%) with BAC had recurrence, including both local and distant recurrence. CONCLUSIONS: The histological subtype in adenocarcinoma significantly correlated with the prognosis. In BACs with recurrence or pathological stage II-IV, these tumours might have been classified as invasive adenocarcinoma rather than as BAC. The need for the rigorous pathological evaluation of adenocarcinomas that are considered to be a preinvasive or minimally invasive tumour should be addressed in the new lung adenocarcinoma classification to be proposed by the International Association for the Study of Lung Cancer, the American Thoracic Society and the European Respiratory Society.