| Objective: To analyze the effect of micropapillary structure layer and other factors on the prognosis of pulmonary adenocarcinoma with a micropapillary pattern(MPPAC)in lung adenocarcinoma with micropapillary structure and the prognostic stratification evaluation of micropapillary structure layer combined with Tumor Node Metastasis(TNM)staging.Methods: A total of 108 patients with lung adenocarcinoma with micropapillary structure who underwent surgery for lung cancer in the Department of Thoracic Surgery,Taizhou People Hospital from August 2015 to September 2019 were retrospectively analyzed.Collect the basic information of the patient(such as: gender,age),postoperative pathological information(such as: proportion of micropapillary structure in the cancer,whether there is lymph node metastasis,whether there is obvious vascular tumor thrombus,whether there is obvious pleural involvement,small primary cancer enlargement).Among them,the pathological sections were reviewed by two highly qualified pathologists using a double-blind method.The age was bounded by 60 years,and the age was stratified;the proportion of micropapillary structure in the cancer was bounded by 10%,and the stratification was performed;the size of the cancer was grouped by ≤ 3 cm,> 3 cm and ≤ 5 cm,and > 5 cm;and TNM staging was performed according to the 8th edition of the American Joint Committee on Cancer(AJCC)guidelines.A total of 108 included patients were followed up by telephone for recurrence,metastasis and death.The collected data were statistically analyzed.Results:There were significant differences in the proportion of micropapillary structure in MPPAC(stratified by the proportion of micropapillary structure in 10% of cancer)between the presence or absence of pleural involvement(χ~2 = 4.995,p = 0.026),lymph node metastasis(χ~2 = 5.150,p = 0.023),vascular tumor thrombus(χ~2 = 6.734,p = 0.009)and nerve involvement(χ~2 = 6.739,p = 0.009);there was no significant difference in age stratification(χ~2= 0.023,p = 0.881),gender(χ~2= 1.277,p = 0.258)and tumor size(cχ~2= 4.401,p = 0.114).Univariate results showed that the proportion of micropapillary structure(p = 0.001),the presence or absence of lymph node metastasis(p = 0.034),and the presence or absence of vascular tumor thrombus(p = 0.004)had statistical significance in progression free survival(PFS)of MPPAC patients.The proportion of micropapillary structure(p < 0.001)and the presence or absence of vascular tumor thrombus(p = 0.002)had statistical significance for the overall survival(OS)of MPPAC patients after surgery.Multivariate results showed that the percentage of micropapillary structure(RR = 2.693,p = 0.035),tumor size(p = 0.039),and the presence or absence of vascular tumor thrombus(RR = 3.096,p = 0.014)were independent factors affecting RFS.Meanwhile,the percentage of micropapillary structure(RR = 8.019,p = 0.011)was an independent factor affecting OS.Among them,the ratio of micropapillary structure to layer factor is an independent factor affecting the prognosis of patients with MPPAC.Univariate results showed that the proportion of micropapillary structure content(p < 0.001),the presence or absence of pleural involvement(p = 0.018),and the presence or absence of vascular tumor thrombus(p =0.003)were statistically significant for RFS in MPPAC patients.Multivariate analysis showed that the proportion of micropapillary structure content(RR = 7.193,p = 0.008),tumor size(RR = 4.609,p = 0.031),and the presence or absence of vascular metastasis(RR = 6.828,p = 0.003)were independent factors affecting RFS in MPPAC patients.Conclusions:1.When the proportion of micropapillary structure in the pathological samples of MPPAC patients was > 10%,the incidence of pleural and vascular tumor thrombus,lymphatic metastasis rate and the probability of nerve involvement were higher than those of micropapillary structure ≤ 10%.2.The proportion of micropapillary structure in MPPAC is an independent factor throughout MPPAC.When the proportion of micropapillary structure is > 10%,its prognosis is significantly worse than that when the proportion of micropapillary structure is ≤ 10%.3.The proportion of micropapillary structure in MPPAC is an independent factor affecting in patients with stage I MPPAC.The more the proportion of micropapillary structure in stage I,the worse prognosis than that of micropapillary content ≤ 10%. |
