title: [Prognostic significance of the changes of elastic fibers in acinar predominant or papillary-predominant pulmonary adenocarcinomas].
abstract: OBJECTIVE
  To evaluate the role of elastic fiber changes in predicting survival outcomes in intermediate-grade lung adenocarcinoma.
  
  
  METHODS
  All pulmonary adenocarcinoma resections conducted between January 2009 and December 2009 were reviewed. Pathologically confirmed adenocarcinomas smaller than 3 cm were included in the present study. All cases were categorized into three elastic fiber patterns (EFP): complete loss as pattern Ⅰ (EFP Ⅰ), partial loss as pattern Ⅱ (EFP Ⅱ), normal and diffusely increase as pattern Ⅲ (EFP Ⅲ). Patients with different EFP were compared.
  
  
  RESULTS
  One hundred and ninety four patients were included in this study, with 67(34.5%), 70(36.1%)and 57(29.4%) cases presenting as EFP Ⅰ, EFP Ⅱ, and EFP Ⅲ, respectively. Lymph nodal metastases occurred in 35.8% (24/67), 40.0% (28/70), and 10.5% (6/57) of EFP Ⅰ, EFP Ⅱ and EFP Ⅲ patterns, respectively. The percentage of EFP Ⅰ and Ⅱ increased with increasing tumor size, these patterns occurring in 55.1% (38/69) of tumors ≤2.0 cm, and 79.2% (99/125) of tumors 2.1-3.0 cm in sizes, respectively. The overall 5-year overall survival rate was 75.8%, and 67.2% for EFP I, 68.6% for EFP II, and 94.7% for EFP Ⅲ.
  
  
  CONCLUSIONS
  In patients with intermediate-grade lung adenocarcinoma, EFP should be formally recognized as a feature of tumor invasion, and its evaluation can help to recognize tumor invasive and access clinical prognosis.
authors.affiliation: Department of Thoracic Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
authors.forename: H K
authors.initials: HK
authors.lastname: Xie
authors.forename: J Y
authors.initials: JY
authors.lastname: Zha
authors.forename: L L
authors.initials: LL
authors.lastname: Zhao
authors.forename: L P
authors.initials: LP
authors.lastname: Zhang
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.forename: G
authors.initials: G
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000077192:Adenocarcinoma of Lung; D000231:Adenocarcinoma, Papillary / Q000473:pathology*; D004547:Elastic Tissue / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate