Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern
Background: Lung adenocarcinoma exhibits heterogeneity among different histological subtypes, with solid and micropapillary subgroups (classified as high-grade) associated with worse prognosis. The aim of this retrospective study was to investigate the impact of high-grade adenocarcinoma on survival...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-02-01
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| Series: | Life |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-1729/15/3/339 |
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| Summary: | Background: Lung adenocarcinoma exhibits heterogeneity among different histological subtypes, with solid and micropapillary subgroups (classified as high-grade) associated with worse prognosis. The aim of this retrospective study was to investigate the impact of high-grade adenocarcinoma on survival in patients undergoing intentional thoracoscopic segmentectomy. Methods: Patients who underwent segmentectomy for clinical-stage IA non-small-cell lung cancer between 2016 and 2023 were reviewed. The adenocarcinoma population was divided and compared based on the presence of high-grade adenocarcinoma >20%, based on the 2021 WHO classification. Survival probabilities were estimated using the Kaplan–Meier method and log-rank test. The Cox proportional hazard regression model was used to test the association between survival and covariates. Results: The adenocarcinoma population included 216 patients, with high-grade adenocarcinoma >20% in 47 (21.7%). A consolidation-to-tumor ratio >0.8 was more frequent in the high-grade adenocarcinoma population. Survival analyses showed that overall (5-year OS rate 57% vs. 90%, <i>p</i> < 0.01), cancer-specific (5-year CSS rate 66% vs. 91%, <i>p</i> < 0.01) and disease-free survival (5-year DFS rate 53% vs. 75%, <i>p</i> < 0.01) were significantly worse in patients with high-grade adenocarcinoma. No significant differences in overall and disease-free survival were observed when compared to a contemporary cohort of lobectomy patients. Recurrence and high-grade pattern (HR 3.26, 95%CI 1.4–7.6, <i>p</i> < 0.01) were significant risk factors for reduced overall survival, whereas high-grade adenocarcinoma >20% (HR 2.43, 95%CI 1.25–4.71, <i>p</i> < 0.01) and a consolidation-to-tumor ratio >0.8 were risk factors for reduced disease-free survival. Conclusions: The prognosis of high-grade adenocarcinoma is sub-optimal even in radically treated early-stage patients, and close monitoring and a complete bio-molecular assessment should be advisable in light of a multimodal adjuvant approach. However, the different subtypes of adenocarcinoma could be inserted as a staging parameter in future international staging systems. |
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| ISSN: | 2075-1729 |