Prognostic Significance of Micropapillary Pattern and Risk Factors in Patients With Resected Stage I Lung Adenocarcinoma and Possible Benefit of Adjuvant Therapy: A Real-World Multicenter Study

Authors

Jianjie Li
Yujia Chi
Bo Jia
Qiwen Zheng
Minghan Yuan
Jianjun Zhang
Aishen Zhou
Wei Sun
Yue Yang
Jun Zhao
Tongtong An
Yuyan Wang
Minglei Zhuo
Xue Yang
Hanxiao Chen
Jingjing Wang
Xiaoyu Zhai
Yidi Tai
Yuling He
Lingdong Kong
Xumeng Ji
Yiliang Liu
Nan Wu
Ken Onodera
Paul Van Schil
Mathew Thomas
Fan Yang
Ziping Wang

Publication Date

7-31-2025

Journal

Translational Lung Cancer Research

DOI

10.21037/tlcr-2025-698

PMID

40799419

PMCID

PMC12337073

PubMedCentral® Posted Date

7-28-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Micropapillary (MP) pattern has been identified as a negative prognostic factor in patients with lung adenocarcinoma, but it has not been recognized as a high-risk factor for patients with stage IB lung adenocarcinoma treated with adjuvant chemotherapy. This multicenter cohort study aimed to evaluate the prognostic value of histological subtypes for stage I lung adenocarcinoma and to determine the relative survival benefit of adjuvant chemotherapy for subgroups based on MP pattern.

Methods: This retrospective study included 412 patients with stage I lung adenocarcinoma [according the eighth edition of the tumor-node-metastasis (TNM) classification] with MP pattern who underwent complete surgical resection between January 2010 and December 2019. Patients were classified into 3 groups based on the proportion of MP component (10% and 50% as the threshold): MP component >50% (n=8), 10-50% (n=273) and < 10% (n=131).

Results: Among the 412 patients, the median age was 63 years, and 73.4% (113/154) patients with MP component ≥10% and 63.8% (51/80) of those with MP component < 10% had epidermal growth factor receptor (EGFR) mutations. Patients with MP component >50% had a shorter overall survival (OS) compared with those with MP components of 10-50% [10-50% vs. >50%: hazard ratio (HR) =0.293, 95% confidence interval (CI): 0.083-1.027; P=0.052] or < 10% (< 10% vs. >50%: HR =0.214, 95% CI: 0.056-0.816; P=0.02). Notably, in the univariate analysis, the factors associated with a worse recurrence-free survival (RFS) were spread-through-air-space (STAS) status (HR =2.131, 95% CI: 1.104-4.112; P=0.02), male sex (HR =1.693, 95% CI: 1.048-2.735; P=0.03), smoking history (HR =1.817, 95% CI: 1.126-2.931; P=0.01), and tumor size >2 cm (HR =1.832, 95% CI: 1.138-2.949; P=0.01).

Conclusions: MP component and risk factors might be considered critical features for patients with stage I lung adenocarcinomas and may inform the selection of patients who may benefit from adjuvant chemotherapy although no randomized evidence is available.

Keywords

Lung adenocarcinoma, micropapillary (MP), stage I, recurrence-free survival (RFS), adjuvant chemotherapy

Published Open-Access

yes

Recommended Citation

Li, Jianjie; Chi, Yujia; Jia, Bo; et al., "Prognostic Significance of Micropapillary Pattern and Risk Factors in Patients With Resected Stage I Lung Adenocarcinoma and Possible Benefit of Adjuvant Therapy: A Real-World Multicenter Study" (2025). Faculty, Staff and Student Publications. 5218.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5218