Prognostic impact of lung adenocarcinoma second predominant pattern from a large European database

Pietro Bertoglio, Giulia Querzoli, Luigi Ventura, Vittorio Aprile, Maria A. Cattoni, Dania Nachira, Filippo Lococo, Maria Rodriguez Perez, Francesco Guerrera, Fabrizio Minervini, Letizia Gnetti, Diana Bacchin, Francesca Franzi, Guido Rindi, Salvatore Bellafiore, Federico Femia, Andrea Viti, Giuseppe S. Bogina, Peter Kestenholz, Enrico RuffiniMassimiliano Paci, Stefano Margaritora, Andrea S. Imperatori, Marco Lucchi, Luca Ampollini, Alberto C. Terzi

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Background and Objectives: Adenocarcinoma patterns could be grouped based on clinical behaviors: low- (lepidic), intermediate- (papillary or acinar), and high-grade (micropapillary and solid). We analyzed the impact of the second predominant pattern (SPP) on disease-free survival (DFS). Methods: We retrospectively collected data of surgically resected stage I and II adenocarcinoma. Selection criteria: anatomical resection with lymphadenectomy and pathological N0. Pure adenocarcinomas and mucinous subtypes were excluded. Recurrence rate and factors affecting DFS were analyzed according to the SPP focusing on intermediate-grade predominant pattern adenocarcinomas. Results: Among 270 patients, 55% were male. The mean age was 68.3 years. SPP pattern appeared as follows: lepidic 43.0%, papillary 23.0%, solid 14.4%, acinar 11.9%, and micropapillary 7.8%. The recurrence rate was 21.5% and 5-year DFS was 71.1%. No difference in DFS was found according to SPP (p =.522). In patients with high-grade SPP, the percentage of SPP, age, and tumor size significantly influenced DFS (p =.016). In patients with lepidic SPP, size, male gender, and lymph-node sampling (p =.005; p =.014; p =.038, respectively) significantly influenced DFS. Conclusions: The impact of SPP on DFS is not homogeneous in a subset of patients with the intermediate-grade predominant patterns. The influence of high-grade SPP on DFS is related to its proportion in the tumor.
Original languageEnglish
Pages (from-to)560-569
Number of pages10
JournalJournal of Surgical Oncology
Publication statusPublished - 2021


  • Adenocarcinoma of Lung
  • Adenocarcinoma, Papillary
  • Aged
  • Carcinoma, Acinar Cell
  • Databases, Factual
  • Europe
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms
  • Male
  • Neoplasm Recurrence, Local
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • lung adenocarcinoma
  • lung cancer biology
  • lung cancer surgery
  • non-small-cell lung cancer


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