Introduction: Lung adenocarcinoma (LUAD) is the leading cause of cancer-related mortality worldwide. Acinar is the most prevalent architectural pattern and is associated with an intermediate prognosis. Several studies have investigated the prognosis of acinar-predominant LUAD patients. Here, we aimed to move beyond the acinar-predominant classification and gain a more comprehensive understanding of how acinar minor components influence prognosis specifically when accompanying other histological patterns in LUAD. Methods: Patients were grouped by the proportion of acinar patterns in their tumors: acinar-predominant (AP), and acinar component (AC; non-acinar predominant LUAD with an acinar component of ≥5%). The clinicopathologic characteristics, recurrence-free survival (RFS), and a panel of well-characterized driver mutations, includingKRAS,EGFR,BRAF,MET, andPIK3CA, were investigated in the two groups of patients. Results: Among 1263 LUAD patients, 716 (56.7%) were AP, and 547 (43.3%) were AC. In AP, the frequency ofEGFRexon 19 deletions (EGFR-Del 19) was significantly higher than in AC (p= 0.014). AC demonstrated a worse RFS than AP in the unadjusted analysis (log-rankp: 0.006). In stage I, the difference in the RFS of AC in comparison to AP remained significant (p= 0.048). In the multivariable analysis, AC was significantly associated with a worse RFS in comparison to AP (hazard ratio [HR] AC vs. AP: 1.240, 95% CI: 1.103–1.312,p: 0.04), even after adjusting for other histological patterns, the mutational status, and relevant clinicopathological features. The post-recurrence survival was significantly better in patients with an acinar component of ≥5% who received EGFR tyrosine kinase inhibitors (TKIs) compared to those who did not receive TKIs (p= 0.033). Conclusions: While the predominant pattern primarily dictates prognosis in LAUD, the presence of an acinar minor component alongside other high-grade patterns may further worsen outcomes. This underscores the necessity of considering the broader histological landscape rather than focusing solely on predominant patterns, as our findings show that minor acinar components can impact RFS alongside other histological patterns.
引言：肺腺癌（LUAD）是全球癌症相关死亡的主要原因。腺泡型是最常见的组织结构模式，其预后处于中等水平。多项研究已探讨了以腺泡型为主的LUAD患者的预后。本研究旨在超越以腺泡型为主的分类方式，更全面地理解当腺泡型作为次要成分伴随其他组织学模式出现时，如何具体影响LUAD的预后。 方法：根据肿瘤中腺泡型模式的比例将患者分组：腺泡型为主型（AP）和腺泡成分型（AC；非腺泡型为主但腺泡成分≥5%的LUAD）。研究比较了两组患者的临床病理特征、无复发生存期（RFS）以及一组特征明确的驱动基因突变，包括KRAS、EGFR、BRAF、MET和PIK3CA。 结果：在1263例LUAD患者中，AP组716例（56.7%），AC组547例（43.3%）。AP组中EGFR外显子19缺失（EGFR-Del 19）的频率显著高于AC组（p=0.014）。在未调整的分析中，AC组的RFS较AP组更差（对数秩检验p=0.006）。在I期患者中，AC组与AP组的RFS差异仍然显著（p=0.048）。多变量分析显示，即使在调整了其他组织学模式、突变状态及相关临床病理特征后，与AP组相比，AC组仍与较差的RFS显著相关（风险比[HR] AC vs. AP：1.240，95% CI：1.103–1.312，p=0.04）。在腺泡成分≥5%的患者中，接受EGFR酪氨酸激酶抑制剂（TKI）治疗者的复发后生存期显著优于未接受TKI治疗者（p=0.033）。 结论：虽然主要模式主导着LUAD的预后，但腺泡型次要成分与其他高级别模式共存时可能进一步恶化预后。这强调了考虑更广泛的组织学背景而非仅关注主要模式的必要性，因为我们的研究结果表明，次要的腺泡成分能与其他组织学模式共同影响RFS。
肿瘤(癌症)患者之家