[Association between the presence of solid or micropapillary components and survival outcome in stage ⅠA lung adenocarcinoma cases: a retrospective cohort study].

Objectives: To examine the influence of the proportion of pathological subtypes on the prognosis of stage ⅠA lung adenocarcinoma cases, and to explore the association between the presence/absence of solid or micropapillary (S/M) components and survival outcome. Methods: Totally 321 patients with stage ⅠA lung adenocarcinoma who received complete surgical resection at Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital from January 2011 to December 2013 were retrospectively analyzed. There were 130 males and 191 females, aging 59(11) years (M(IQR)) (range: 55 to 66 years). The diagnostic value of the proportion of each pathological growth subtype on relapse-free survival (RFS) and overall survival (OS) were analyzed by using receiver operator characteristic curve. Patients were firstly divided into two groups according to the presence or absence of S/M components. And patients without S/M components were farther divided into two groups according to predominant growth pattern. There were three groups in total: with S/M components (group S/M+), without S/M components and lepidic growth pattern predominant (group S/M-LPA), without S/M components and papillary or acinar growth pattern predominant (group S/M-P/A). Kaplan-Meier method were used to draw the survival curves of the three groups, and Log-rank test were used to compare RFS and OS among the three groups. Cox proportional risk model was used to verify whether the presence of S/M components was a prognostic factor on RFS. Results: The proportion of S/M components had no diagnostic value for recurrence (solid: area under curve (AUC)=0.588, P=0.095; micropapillary: AUC=0.566, P=0.106) and death (AUC=0.589, P=0.104; AUC=0.607, P=0.056). The 5-year RFS rate of group S/M-LPA, S/M-P/A and S/M+ were 92.4%, 82.3% and 77.3%, respectively (all P<0.05), while the 5-year OS rate were 97.4%, 94.5% and 83.2%, respectively (all P<0.05). Multivariable analysis showed that the 3 groups were independent predictors of recurrence (S/M-P/A vs. S/M- LPA: HR=2.691, 95%CI: 1.249 to 5.799, P=0.011; S/M+vs. S/M-LPA, HR=6.763, 95%CI: 3.050 to 14.996, P<0.01). Conclusions: The proportion of S/M components in stage ⅠA lung adenocarcinoma with complete resection cases did not affect survival outcome. New grouping method based on the presence or absence of S/M components were significantly associated with patient survival outcomes: S/M+ patients had the worst prognosis and S/M-LPA patients had the best prognosis.目的： 探讨ⅠA期肺腺癌各病理学亚型成分比例对预后的影响，以及实体型或微乳头型成分（S/M成分）对预后的影响。 方法： 回顾性分析2011年1月至2013年12月在同济大学附属上海市肺科医院接受完整手术切除的321例ⅠA期肺腺癌患者的资料。男性130例，女性191例，年龄59（11）岁［M（IQR）］（范围：55~66岁）。采用受试者工作特征曲线分析各病理学亚型成分比例对无复发生存和总体生存的判断价值。根据有无S/M成分将患者分为2组，其中无成分组又根据主型不同分为2组：含S/M成分组（S/M+组）120例、无S/M成分且贴壁型为主型组（S/M-LPA组）129例、无S/M成分且腺管型或乳头型为主型组（S/M-P/A组）72例。采用Kaplan-Meier法绘制3组生存曲线，Log-rank检验进行组间比较。采用Cox比例风险模型验证有无S/M成分是否为预后因素。 结果： S/M成分对于复发（实体型成分：曲线下面积=0.588，P=0.095；微乳头型成分：曲线下面积=0.566，P=0.106）和死亡（曲线下面积=0.589，P=0.104；曲线下面积=0.607，P=0.056）无诊断价值。S/M-LPA组、S/M-P/A组、S/M+组的5年无复发生存率分别为92.4%、82.3%、77.3%（两两比较：P值均<0.05），5年总体生存率分别为97.4%、94.5%、83.2%（两两比较：P值均<0.05）。多因素分析结果显示，新分组（S/M-P/A组比S/M-LPA组：HR=2.691，95%CI：1.249~5.799，P=0.011；S/M+组比S/M-LPA组：HR=6.763，95%CI：3.050~14.996，P<0.01）是复发的预后因素。 结论： 对于完整切除的、存在S/M成分的ⅠA期肺腺癌患者，S/M成分比例并不影响预后。基于S/M成分有无的新分组是患者复发的预后因素，S/M+组患者预后最差，S/M-LPA组患者的预后最佳。.