title: COPD-related adenocarcinoma presents low aggressiveness morphological and molecular features compared to smoker tumours.
abstract: OBJECTIVE
  Adenocarcinoma comprises a group of diseases with heterogeneous clinical and molecular characteristics. COPD and lung cancer are strictly related; to date it is unknown if COPD-associated cancers have different features from tumours arising in non-COPD patients. Our aim was to study COPD-associated adenocarcinoma phenotypes mainly focusing on morphological and molecular aspects, in comparison to smoke-related cancer without COPD.
  
  
  METHODS
  From 2010 to 2013, 54 patients with adenocarcinoma (20 COPD and 34 smokers) were prospectively studied. Each patient underwent a complete clinical and instrumental assessment. Morphological studies included analysis of growth pattern, cell proliferation (Ki-67/MIB1 expression) and parameters of intra- and peri-tumoral remodelling (inflammation, fibrosis and necrosis). Genetic analysis of EGFR and KRAS mutations was also performed.
  
  
  RESULTS
  The two groups were comparable for the main demographic and biohumoral parameters except for increased blood basophil cell count in the COPD group. Compared to COPD, tumours of smokers presented an increased percentage of solid component (median: 20% vs 5%, p=0.02), a reduced percentage of lepidic pattern (median: 0% vs 10%, p=0.06) and higher Ki-67/MIB1 median value (55% vs 30%, p=0.02). In multivariate analysis lepidic and solid histological pattern were significantly influenced by clinical group (p=0.03 and 0.05, respectively). Concerning EGFR mutation, no differences were found between groups while KRAS mutation presented a trend of higher percentage in smokers compared to COPD (41% vs 20%, p=NS). Adenocarcinoma with KRAS mutation showed a higher value of Ki-67/MIB1 (65% vs 35%, p=0.048) and prevalent solid pattern (35% vs 10%, p=0.019) in comparison to wild-type form.
  
  
  CONCLUSIONS
  COPD-related adenocarcinoma presents molecular and morphological features of lower aggressiveness (increased lepidic component, reduced solid pattern, lower cell proliferation and less frequent KRAS mutation) compared to smokers. Different molecular mechanisms could be associated with the development of COPD associated cancer.
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy. Electronic address: marco.schiavon@unipd.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Schiavon
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Nazarena
authors.initials: N
authors.lastname: Nannini
authors.affiliation: Istituto Oncologico Veneto, Via Gattamelata 64, 35128 Padova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pasello
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lunardi
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Balestro
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rebusso
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Saetta
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Via N. Giustiniani 2, 35128 Padova, Italy.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Calabrese
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000235:genetics / Q000473:pathology*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D001491:Basophils / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000235:genetics / Q000473:pathology*; D066246:ErbB Receptors / Q000097:blood / Q000235:genetics; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000097:blood / Q000235:genetics; D008175:Lung Neoplasms / Q000097:blood / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000235:genetics / Q000473:pathology*; D012907:Smoking / Q000009:adverse effects*; D018631:ras Proteins / Q000097:blood / Q000235:genetics
chemical_list: C117307:KRAS protein, human; D019394:Ki-67 Antigen; D011518:Proto-Oncogene Proteins; D066246:ErbB Receptors; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins
keywords: Adenocarcinoma; Basophils in blood; COPD; KRAS; Ki-67/MIB1; Morphological pattern