| BACKGROUND:Lung cancer has a high incidence and mortality rate both in china and around the world.Since the Association for the Study of Lung Cancer(IASLC),American Thoracic Society(ATS)and European Respiratory Society(ERS)published the international multidisciplinary new classification for lung adenocarcinoma in 2011,it has been shown that there was prognostic difference between the subtypes in the classification.However,it is not clear that whether there is differences in the prognosis of patients with acinar predominant adenocarcinoma(ACN)and patients with papillary predominant adenocarcinoma(PAP).Furthermore,the appropriate surgical plan for patients with ACN and patients with PAP is undetermined.METHODS:Data in this study were collected from the surveillance,Epidemiology,and End Results(SEER)public database.1531 patients,including 1047 patients with ACN and 484 patients with PAP,were included.Propensity score matching(PSM)with a 1:1 ratio was used to create two groups of patients with ACN and PAP patients with similar profiles(age,gender,race,T stage,the degree of tumor differentiation,the treatment history of radiation,the treatment history of chemotherapy and their surgical approaches).The primary outcome in this study was overall survival(OS)and lung cancer specific survival(LCSS).The Kaplan-Meier method was used to estimate OS and LCSS of patients with lung adenocarcinoma,while the survival prognosis of patients with ACN or those with PAP was evaluated.The log-rank test was performed to make comparisons of survival curves between subgroups.Statistical significance was defined as p<0.05.And multivariate Cox regression was used to control the confounding factors between the three groups of surgical approaches and estimate the OS and LCSS of patients who received Wed,Seg or Lob in ACN group or PAP group.RESULTS:After propensity score matching with a 1:1 ratio,968 patients in stage I,including 484 patients with ACN and 484 patients with PAP,were included.There was no statistically significant difference of clinicopathological characteristics,including age at diagnosis,race,gender,T stage,tumor size,grade of differentiation and treatment history of radiotherapy,treatment history of chemotherapy or surgery approaches,between ACN group and PAP group.According to the results of survival analysis,patients with ACN had a more favorable OS than those with PAP(p=0.001).PAP patients had a median OS of 101 months,while those with ACN did not reach their median OS(mean of OS:109.532±4.517 months).The 3-year OS rate and 5-year OS rate for patients with ACN were 87.5%(95%CI:83.97%-91.03%)and 77.9%(95%CI:72.22%-83.58%),respectively,while those with PAP had a 3-year OS rate and 5-year OS rate of 78.9%(95%CI:74.98%-82.82%)and 67.0%(95%CI:61.90%-72.10%).Besides,both patients with ACN and those with PAP did not reach their median LCSS,with a mean of LCSS of 126.08 ± 3.95 months and 115.83± 3.42 months,respectively.Patients with ACN and those with PAP had a 3-year LCSS rate of 92.1%(95%CI:89.16%-95.04%)and 85.6%(95%CI:82.07%-89.13%),respectively,and had a 5-year LCSS rate of 87.5%(95%CI:83.19%-91.81%)and 77.6%(95%CI:72.90%-82.30%),respectively.Among patients with ACN stage I,those who received lobectomy with mediastinal lymph node dissection(Lob)(p=0.001)or segmentectomy(Seg)(p=0.003)had a significantly better OS than those who underwent wedge resection(Wed).Compared to those who received Wed,the HR for OS of patients who underwent Seg and Lob was 0.318(95%CI:0.113-0.894,p=0.003)and 0.520(95%CI:0.357-0.757,p=0.001).Further more,there was no difference between patients who received Seg and those who received Lob.The HR for OS of patients who underwent Lob was 1.635(95%CI:0.600-4.459,p=0.337),compared to patients received Seg.As for LCSS,those who received Lob or Seg seem to have a better LCSS than those underwent Wed,though the difference between the two groups was not statistically significant.While compared to those received Wed,patients who underwent Seg and Lob had a HR for LCSS of 0.687(95%CI:0.232-2.035,p=0.498)and 0.641(95%CI:0.379-1.085,p=0.098),respectively.Patients who received Lob(HR,0.934,95%CI:0.337-2.857)had a similar LCSS compared to those underwent Seg(p=0.895).For patients with PAP in stage I,those who received Lob seem to had a better OS than those who underwent Wed or Seg,though the difference between them was not statistically significant.Compared with those who received Wed,the HR for OS of patients who underwent Lob was 0.605(95%CI:0.263-1.393,p=0.237).And compared to those who underwent Seg,patients that received Lob had a HR for OS of 0.735(95%CI:0.481-1.123,p=0.154).Further more,there was no difference between patients who received Seg and those who received Lob.The HR for OS of patients who underwent Lob was 1.635(95%CI:0.600-4.459,p=0.337),compared to patients received Seg.As for LCSS,those who received Lob tend to had a better prognosis of LCSS than those who underwent Wed or Seg,though the difference between them was not statistically significant.The HR for LCSS of patients who underwent Lob was 0.688(95%CI:0.402-1.180,p=0.174),while compared to those received Wed.And patients that received Lob had a HR for OS of 0.541(95%CI:0.194-1.504,p=0.239),compared to those who underwent Seg.What's more,there was no difference between patients who received Wed and those who received Lob.The HR for LCSS of patients who underwent Seg was 1.273(95%CI:0.423-3.385,p=0.668),compared to patients who received Seg.CONCLUSIONS:Among patients with lung adenocarcinoma in stage I,those with ACN have a better OS and LCSS than that with PAP.For patients with ACN in stage I,Seg and Lob,rather than Wed,seem to be an equivalent treatment choice;however,Seg is the prior option because it could preserve more lung function and provide a better quality for them than Lob.For patients with PAP in stage I,Lob tend to be a better choice than Wed and Seg,although the prognostic difference between them is non-significant. |
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