Impact of High-Grade Patterns in Early-Stage Lung Adenocarcinoma: A Multicentric Analysis

Pietro Bertoglio, Vittorio Aprile, Luigi Ventura, Maria Cattoni, Dania Nachira, Filippo Lococo, Maria Rodriguez Perez, Francesco Guerrera, Fabrizio Minervini, Giulia Querzoli, Giovanni Bocchialini, Diana Bacchin, Francesca Franzi, Guido Rindi, Salvatore Bellafiore, Federico Femia, Giuseppe Salvatore Bogina, Piergiorgio Solli, Peter Kestenholz, Enrico RuffiniMassimiliano Paci, Stefano Margaritora, Andrea Selenito Imperatori, Marco Lucchi, Letizia Gnetti, Alberto Claudio Terzi

Research output: Contribution to journalArticle


Objective: The presence of micropapillary and solid adenocarcinoma patterns leads to a worse survival and a significantly higher tendency to recur. This study aims to assess the impact of pT descriptor combined with the presence of high-grade components on long-term outcomes in early-stage lung adenocarcinomas. Methods: We retrospectively collected data of consecutive resected pT1-T3N0 lung adenocarcinoma from nine European Thoracic Centers. All patients who underwent a radical resection with lymph-node dissection between 2014 and 2017 were included. Differences in Overall Survival (OS) and Disease-Free Survival (DFS) and possible prognostic factors associated with outcomes were evaluated also after performing a propensity score matching to compare tumors containing non-high-grade and high-grade patterns. Results: Among 607 patients, the majority were male and received a lobectomy. At least one high-grade histological pattern was seen in 230 cases (37.9%), of which 169 solid and 75 micropapillary. T1a-b-c without high-grade pattern had a significant better prognosis compared to T1a-b-c with high-grade pattern (p = 0.020), but the latter had similar OS compared to T2a (p = 0.277). Concurrently, T1a-b-c without micropapillary or solid patterns had a significantly better DFS compared to those with high-grade patterns (p = 0.034), and it was similar to T2a (p = 0.839). Multivariable analysis confirms the role of T descriptor according to high-grade pattern both for OS (p = 0.024; HR 1.285 95% CI 1.033–1.599) and DFS (p = 0.003; HR 1.196, 95% CI 1.054–1.344, respectively). These results were confirmed after the propensity score matching analysis. Conclusions: pT1 lung adenocarcinomas with a high-grade component have similar prognosis of pT2a tumors.
Original languageEnglish
Pages (from-to)649-660
Number of pages12
Publication statusPublished - 2022


  • Adenocarcinoma subtypes
  • TNM staging
  • Lung cancer
  • Lung adenocarcinoma


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