title: Lepidic and micropapillary growth pattern and expression of Napsin A can stratify patients of stage I lung adenocarcinoma into different prognostic subgroup.
abstract: Histologic categories and related growth pattern proposed by IASLC/ATS/ERS classification has been reported to be prognostically important in lung adenocarcinoma. Thyroid transcription factor-1 (TTF1) and Napsin A have been investigated as potential prognostic parameters with conflicting results. A total of 211 cases with stage I lung adenocarcinoma were analyzed according to the IASLC/ATS/ERS classification with slight modifications. Expression levels of TTF1 and Napsin A were evaluated by immunohistochemistry. In univariate analyses, we found female sex (p=0.009), lepidic growth pattern (P=0.011) and lack of micropapillary pattern (P=0.048) were favorable predictor significantly associated with disease-free survival (DFS). Lack of mitosis (P=0.044) and Napsin A expression (P=0.031) were favorable predictors for overall survival (OS). Tumors with a maximum diameter≤2 cm had both longer DFS (P=0.008) and OS (P=0.020). Negative TTF1 expression indicated increased risk of death, but failure in statistical significance (P=0.215). After multivariate analysis, histologic subtype, tumor size and gender were identified as independent predictor for DFS (RR: 0.343, 3.697, 0.494; P=0.006, 0.029, 0.019), no feature was found as an independent predictor for overall survival (P>0.05). To conclude, lepidic growth pattern, female sex and tumor size≤2 cm are independent favorable predictors for tumor recurrence, tumors with more than 5% percentage of lepidic growth pattern will have a better prognosis than absence, in early-stage lung adenocarcinoma.
authors.affiliation: Department of Pathology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Molecular Oncology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Pathology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Lian
authors.affiliation: Department of Pathology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Pathology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wen
authors.affiliation: Department of Pathology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Xiu-Yun
authors.initials: XY
authors.lastname: Liu
authors.affiliation: Department of Pathology, Cancer Institute and Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Lin
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016282:Aspartic Acid Endopeptidases / Q000378:metabolism*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D049109:Cell Proliferation; D015331:Cohort Studies; D004268:DNA-Binding Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D014157:Transcription Factors
chemical_list: D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C504003:TTF1 protein, human; D014157:Transcription Factors; D016282:Aspartic Acid Endopeptidases; C498549:NAPSA protein, human
keywords: IASLC/ATS/ERS classification; Napsin A; Stage I; TTF1; lung adenocarcinoma; prognosis