Inclusion of multiple high‐risk histopathological criteria improves the prediction of adjuvant chemotherapy efficacy in lung adenocarcinoma

Sereno, M. et al. (2021) Inclusion of multiple high‐risk histopathological criteria improves the prediction of adjuvant chemotherapy efficacy in lung adenocarcinoma. Histopathology, 78(6), pp. 838-848. (doi: 10.1111/his.14301) (PMID:33155719) (PMCID:PMC8247971)

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Aims: The decision to consider adjuvant chemotherapy (AC) for non‐small cell lung cancer is currently governed by clinical stage. This study aims to assess other routinely collected pathological variables related to metastasis and survival for their ability to predict the efficacy of AC in lung adenocarcinoma. Methods and results: A retrospective single‐centre series of 620 resected lung non‐mucinous adenocarcinoma cases from 2005 to 2015 was used. Digital images of all slides were subjected to central review, and data on tumour histopathology, AC treatment and patient survival were compiled. A statistical case matching approach was used to counter selection bias. Several high‐risk pathological criteria predict both pathological nodal involvement and early death: positive vascular invasion status (VI+) (HR = 2.10, P < 0.001), positive visceral pleural invasion status (VPI+) (HR = 2.16, P < 0.001), and solid/micropapillary‐predominant WHO tumour type (SPA/MPPA) (HR = 3.29, P < 0.001). Crucially, these criteria also identify patient groups benefiting from AC (VI + HR = 0.69, P = 0.167, VPI + HR = 0.44, P = 0.004, SPA/MPPA HR = 0.36, P = 0.006). Cases showing VI+/VPI+/SPA/MPPA histology in the absence of AC stage criteria were common (170 of 620 total), and 8 had actually received AC. This group showed much better outcomes than equivalent untreated cases in matched analysis (3‐year OS 100.0% versus 31.3%). Inclusion of patients with VI+/VPI+/SPA/MPPA histology would increase AC‐eligible patients from 51.0% to 84.0% of non‐mucinous tumours in our cohort. Conclusions: Our data provide preliminary evidence that the consideration of AC in patients with additional high‐risk pathological indicators may significantly improve outcomes in operable lung adenocarcinoma, and that AC may be currently underused.

Item Type:Articles
Additional Information:This work was supported by a Medical Research Council programme (RG94521).
Keywords:adenocarcinoma of lung, adjuvant, biomarkers, chemotherapy, histology, tumour.
Glasgow Author(s) Enlighten ID:Le Quesne, Professor John
Creator Roles:
Le Quesne, J.Conceptualization, Writing – original draft
Authors: Sereno, M., He, Z., Smith, C. R., Baena, J., Das, M., Hastings, R. K., Rake, G., Fennell, D. A., Nakas, A., Moore, D. A., and Le Quesne, J.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Histopathology
Publisher:John Wiley & Sons Ltd.
ISSN (Online):1365-2559
Published Online:06 November 2020
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Histopathology 78:838-848
Publisher Policy:Reproduced under a Creative Commons licence

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