Prognostic Value Of Different Pathological Subtypes Of Early Synchronous Multiple Primary Lung Adenocarcinoma

Objective To explore the clinical factors influencing the prognosis of patients with multiple primary lung adenocarcinoma and analyze the prognostic value of different pathological subtypes of multiple primary lung adenocarcinoma.Methods A total of 229 patients with multiple primary lung adenocarcinoma who received radical lung cancer resection in the Department of Thoracic Surgery,Qilu Hospital of Shandong University from January 2016 to December 2019 were included in the study after strict inclusion and exclusion criteria screening.The relationship between general clinical characteristics,past history,family history,tumor size,tumor distribution,surgical method,lymph node metastasis,pathological subtype,TNM stage and prognosis was analyzed.Kaplan-Meier method was used to calculate 5-year survival rate and draw survival curve,and log-rank method was used to test the difference of survival curve.Univariate and multivariate analyses were performed using Cox proportional regression model.P<0.05 was considered statistically significant.Results 229 patients were followed up,of which 76 patients had recurrence,metastasis or death(33.2%).The median follow-up time was(53±13.9)months,1-year,3-year and 5-year overall survival rates(OS)were 98.3%,88.2%,72.2%,and 1-year,3-year,and 5-year progression-free survival rates(DFS)were 98.3%,84.3%,and 66.1%,respectively.The 5-year OS and 5-year DFS of the carcinoma in situ/microinvasive carcinoma group were 93.3%and 93.3%.The 5-year OS and 5-year DFS of the low-grade group were 74.1%and 74.1%.The 5-year OS and 5-year DFS of middle grade group were 72.3%and 62.1%.The 5-year OS and 5-year DFS of the high-level group were 52.0%and 39.4%,respectively.The 5-year OS and 5-year DFS of the micropapillary/solid-free group were 81.6%and 75.0%respectively.The 5-year OS and 5-year DFS of the micropapillary/solid non-dominant group were 68.1%and 57.3%,respectively.The 5-year OS and 5-year DFS of the micropapillary/solid dominant group were 49.4%and 35.6%,respectively.Univariate analysis showed that smoking history,maximum tumor diameter,high-grade components,lymph node metastasis,visceral pleural invasion,acinar component,solid component and micropapillary component were adverse prognostic factors for DFS and OS in patients with multiple primary lung adenocarcinoma.Papillary components only affect patients’ OS;Patients receiving adjuvant therapy improved progression-free survival,and the survival curve was better than those who did not receive adjuvant therapy,but the difference was not statistically significant.Multivariate analyses showed that maximum diameter of tumor,lymph node metastasis,visceral pleural invasion,acinar component,dominant solid component,non-dominant micropapillary component,and dominant micropapillary component were independent prognostic factors affecting DFS in patients with sMPLA.Maximum diameter of tumor,papillary component,dominant solid component,non-dominant micropapillary component,and dominant micropapillary component were independent prognostic factors affecting OS in patients with multiple primary lung adenocarcinoma.Conclusions 1.Tumor stage,lymph node metastasis,visceral pleural invasion,solid component and micropapillary component are independent risk factors that significantly affect the prognosis of patients.2.Radical resection can significantly improve the prognosis of sMPLA patients.For sMPLA patients without invasive components(carcinoma in situ/microinvasive adenocarcinoma),5-year DFS and 5-year OS are close to 100%.3.Whether the number of lesions and pathological subtypes of sMPLA patients are the same has no significant impact on the prognosis of patients;Postoperative adjuvant chemotherapy did not significantly improve the prognosis of patients with early sMPLA.4.For sMPLA patients,a small amount of micropapilla components will also increase the risk of recurrence and death,so the proportion of each primary pathological subtype in sMPLA patients should be further quantitatively analyzed to establish a stratified prognostic prediction model.