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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2025-02-01
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| author | Stefano Bongiolatti Alberto Salvicchi Lavinia Gatteschi Giovanni Mugnaini Simone Tombelli Alessandro Gonfiotti Luca Voltolini |
| author_facet | Stefano Bongiolatti Alberto Salvicchi Lavinia Gatteschi Giovanni Mugnaini Simone Tombelli Alessandro Gonfiotti Luca Voltolini |
| author_sort | Stefano Bongiolatti |
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| description | 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. |
| format | Article |
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| institution | OA Journals |
| issn | 2075-1729 |
| language | English |
| publishDate | 2025-02-01 |
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| spelling | doaj-art-333dfd382d40440f9a5ea75b69700b9e2025-08-20T01:48:57ZengMDPI AGLife2075-17292025-02-0115333910.3390/life15030339Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma PatternStefano Bongiolatti0Alberto Salvicchi1Lavinia Gatteschi2Giovanni Mugnaini3Simone Tombelli4Alessandro Gonfiotti5Luca Voltolini6Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyThoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyThoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyThoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyThoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyThoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyThoracic Surgery Unit, Careggi University Hospital, 50134 Florence, ItalyBackground: 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.https://www.mdpi.com/2075-1729/15/3/339VATS segmentectomyhigh-grade lung adenocarcinomaoverall survivalrecurrenceVATS–lobectomy |
| spellingShingle | Stefano Bongiolatti Alberto Salvicchi Lavinia Gatteschi Giovanni Mugnaini Simone Tombelli Alessandro Gonfiotti Luca Voltolini Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern Life VATS segmentectomy high-grade lung adenocarcinoma overall survival recurrence VATS–lobectomy |
| title | Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern |
| title_full | Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern |
| title_fullStr | Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern |
| title_full_unstemmed | Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern |
| title_short | Oncologic Outcomes of Thoracoscopic Segmentectomy in Patients with High-Grade Adenocarcinoma Pattern |
| title_sort | oncologic outcomes of thoracoscopic segmentectomy in patients with high grade adenocarcinoma pattern |
| topic | VATS segmentectomy high-grade lung adenocarcinoma overall survival recurrence VATS–lobectomy |
| url | https://www.mdpi.com/2075-1729/15/3/339 |
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