title: Comprehensive study of mutational and clinicopathologic characteristics of adenocarcinoma with lepidic pattern in surgical resected lung adenocarcinoma.
abstract: OBJECTIVE
  Although many studies have explored clinicopathologic characteristics and prognosis of lung adenocarcinoma, a few literatures reported the mutational status of lung adenocarcinomas with lepidic pattern and whether there is difference between adenocarcinomas with pure lepidic component and lepidic predominant adenocarcinomas remain unknown.
  
  
  METHODS
  One hundred and thirty-three patients including 92 adenocarcinomas with pure lepidic component and 41 lepidic predominant adenocarcinomas were subjected to the study. All the clinicopathologic data, the follow-up information and the status of gene mutations including EGFR, KRAS, HER2, BRAF, AKT1, ALK, RET and ROS1 were investigated.
  
  
  RESULTS
  Of the 133 lung adenocarcinomas with lepidic pattern, 87.22 % (116/133) were detected harboring mutations in our tested genes, among which 90.52 % (105/116) harbored EGFR mutation. There are three KRAS mutations and two BRAF mutations in our cohort, and we revealed two ALK fusion and one RET fusion. No ROS1 fusion was discovered. There was no significant difference in gene mutations between adenocarcinomas with pure lepidic component and lepidic predominant adenocarcinomas except EGFR mutation (p = 0.039). Lepidic predominant adenocarcinomas seemed to have more EGFR mutation. The post-recurrence survival was significantly prolonged in patients who received TKIs.
  
  
  CONCLUSIONS
  Adenocarcinoma with lepidic pattern is a low-grade lung tumor with favorable prognosis and displays frequent EGFR mutation. Compared with lepidic predominant adenocarcinomas, lung adenocarcinomas with pure lepidic component have a better prognosis. On the basis of these results, we also suggested the application of EGFR-TKIs therapy for EGFR mutation-positive patients after recurrence could achieve prolonged survival.
authors.affiliation: Department of Thoracic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111XianXia Road, Shanghai, 200336, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Thoracic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111XianXia Road, Shanghai, 200336, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Department of Thoracic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111XianXia Road, Shanghai, 200336, China.
authors.forename: Wenliang
authors.initials: W
authors.lastname: Qian
authors.affiliation: Department of Thoracic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111XianXia Road, Shanghai, 200336, China. shtrzm@126.com.
authors.forename: Min
authors.initials: M
authors.lastname: Zheng
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004252:DNA Mutational Analysis; D005260:Female; D056726:Genetic Association Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009154:Mutation; D017678:Sex Distribution; D016896:Treatment Outcome
keywords: Adenocarcinoma with lepidic pattern; Adenocarcinoma with pure lepidic component; Lepidic predominant adenocarcinoma; Mutations; Prognosis