Study On Clinical Characteristics And Prognosis Among Different Histological Subtypes Of Postoperative Invasive Lung Adenocarcinoma

Objective:Based on the 2011 version of the international multidisciplinary lung adenocarcinoma classification criteria,we want to explore the differences among invasive lung adenocarcinoma histological subtypes by operative treatment in clinical epidemiological features?surgical histological?the time and the sites of metastasis and other relevant indicators.We expect to provide suggestions for the development of postoperative clinical treatment plan,disease evaluation and follow-up plan for the patients with invasive lung adenocarcinoma.Methods:We collected the clinical and histological data of 257 patients who were the first time diagnosed invasive primary lung adenocarcinoma by thoracic surgery in Subei People's Hospital of Jiangsu province.from January 01,2013 to December 31,2016,and divided histological subtype into five groups according to the lung adenocarcinoma classification criteria by the IASLC(international society for the study of lung cancer)/ATS(American thoracic society)/ ERS(European respiratory society)in 2011:papillary group,micropapillary group,acinar group,solid group with mucus production(hereinafter referred to as solid group)and lepidic group.The follow-up time was up to December 31,2018,we dealt with the data which met the requirements by using statistical method,and compared the differences in gender,age,clinical presentation,preoperative CEA(carcinoembryonic antigen),imaging manifestations and other aspects of patients among the five groups,and studied whether the various factors made effects on recurrence and studied the differences among histological subtypes in metastasis time and the metastasis sites.Results:1.Among the 257 enrolled patients,there were 22 in the papillary group,22 in the micropapillary group,121 in the acinar group,52 in the solid group,and 40 in the lepidic group.They accounted for 8.6%,8.6%,47.0%,20.2% and 15.6% of the total sample size;2.In terms of clinical characteristics,the statistics showed that there were no significant differences in age,sex,clinical medical symptoms(finding by health examination,chest pain,sputum with blood,cough with expectoration and other symptoms),preoperation CEA,other imaging features(the sign of burr,blood vessel,pleural pull and vacuole sign),lesion location(whether in the upper lung and whether in the left lung)(p>0.05),while in the history of smoking,lobular of imaging features,focus size,there were significant differences(p < 0.05).The micropapillary group was more common in non-smokers,while the solid group was more common in smokers.The focus size of those two groups was larger than that of other three;3.In terms of postoperative pathology,there was no significant differences in postoperative pleural invasion and vascular invasion among five groups(p>0.05),but in lymph node metastasis and clinical stages,there were significant differences(p<0.001).The micropapillary group and the solid group were more likely to combine with lymph node metastasis;4.In terms of prognosis,a total of 64 patients had taken place recurrence and metastasis among the 257 patients,it's accounting for 24.9% of the total number of samples.The shortest time of recurrence and metastasis was 1 month after surgery,the longest time was 41 months after surgery,and the median time was 17 months after surgery;5.There was significant difference in rate of the recurrence and metastasis among five groups(p<0.05).The recurrence and metastasis rate of the micropapillary group and the solid group were significantly higher than other three.The solid group's recurrence and metastasis time was shorter than others',and it had significant difference(p=0.009).But there was no significant difference in the metastatic site among different histological subtypes;6.Cox proportional hazards regression models suggested that the only factor which could affect the prognosis was the histological subtype.The group of lepidic and papillary had better prognosis,the acinar group's was worse,while the prognosis of the micropapillary group and the solid group were the worst.Conclusion:1.The micropapillary group was more common in non-smokers,while the solid group was more common in smokers;2.The focus size of the micropapillary and the solid groups were larger than that of other three.Those two groups were easier to be with lobular of imaging features;3.The histological subtypes of invasive lung adenocarcinoma could affect the prognosis of postoperative recurrence and metastasis.The prognosis of the micropapillary group and the solid group were the worst than other three.The median time of recurrence and metastasis in the group of solid was significantly shorter than that of the other four groups;4.There was no significant difference in the metastatic site among different histological subtypes.