Study On The Relationship Between The Different Content Ratio Of Micropapillary Pattern And Prognosis In Stage ⅠA Lung Adenocarcinoma

Objective: to investigate the stage ⅠA postoperative lung adenocarcinoma(MPPAC)with micropapillary pattern,so as to confirm the correlation between micropapillary pattern and prognosis,and the close degree of different content proportion of micropapillary pattern to postoperative recurrence.It also provides some reference for the treatment and prognosis of stage ⅠA MPPAC patients after lung cancer surgery.Methods: The substudy subjects were patients WHO underwent video-assisted thoracoscopic lung cancer resection in thoracic surgery of our hospital from 2015 to2020 and were confirmed as stage ⅠA primary adenocarcinoma by postoperative pathological examination.According to the classification standard of lung adenocarcinoma issued by WHO in 2015,346 patients were finally included in the study,including 238 patients with negative micropapillary structure and 108 patients with positive micropapillary structure.Clinical and pathological data of all patients were obtained through the medical record system,including routine data and past medical records of patients.Pathological and imaging data of patients were reviewed at the same time.Clinical data and follow-up data were complete.The study endpoints were disease-free survival and overall survival(deadline: January 2023).SPSS 22.0 software was used for statistical analysis of data in this study.Results: A total of 346 patients were included in the study,including 238 patients with negative micropapillary structure and 108 patients with positive micropapillary structure.Among the clinicopathologic features included in the included patients,MPP-positive patients had statistically significant differences in age(χ~2= 9.88,P=0.002),smoking history(χ~2= 4.77,P =0.029),tumor diameter(χ~2= 24.8,P < 0.001),visceral pleura infiltration(χ~2= 20.0,P < 0.001),pneumoperitoneum dissemination(χ~2= 13.7,P < 0.001),and intravascular cancer thrombi(χ~2= 36.4,P < 0.001) compared with MPP-negative patients visceral pleura infiltration(χ~2= 20.0,P <0.001),airborne dissemination(χ~2= 13.7,P < 0.001)and intravascular cancer thrombi(χ~2= 36.4,P < 0.001)in the MPP positive group was higher than that in the negative group.Patients ≥65 years old and non-smoking in the MPP positive group were more frequent than those in the negative group and had larger and statistically different tumor diameters.However,there was no correlation between the gender differences of the patients and the differences were not statistically significant.Univariate analysis of RFS revealed that smoking(P =0.001),visceral pleura infiltration(P < 0.001),airborne dissemination(P < 0.001),and intravascular cancer thrombi(P < 0.001) were significantly associated with poor prognosis.Relevant clinical data with P <0.15 in univariate analysis were uniformly included in the multivariate analysis.Multivariate analysis showed papillary architecture(HR 3.152;95% CI 1.932-5.034;P < 0.001),visceral pleura infiltration(HR 2.706;95% CI 1.545-4.739;P < 0.001),airborne dissemination(HR 4.522;95% CI 2.613-7.824;P < 0.001),intravascular cancer thrombi(HR 7.708;95% CI 4.031-14.739;P < 0.001)was an independent prognostic factor for RFS in our patient.Among the clinical pathological features of patients with different contents of MPPAC,three subgroups of MPP had significant statistical differences in smoking history(χ~2= 14.9,P < 0.001),airborne dissemination(χ~2= 6.83,P =0.033)and intravascular cancer thrombi(χ~2= 12.3,P =0.002).Univariate analysis of RFS revealed a significant association between airborne dissemination(P =0.036)and intravascular cancer thrombi(P < 0.001)and poor prognosis.Relevant clinical data with P <0.15 in univariate analysis were uniformly included in the multivariate analysis.Multivariate analysis showed airborne dissemination(HR 2.889;95% CI 1.427-5.847;P = 0.003),intravascular cancer thrombi(HR 6.432;95% CI 3.188-12.975;P < 0.001)was an independent prognostic factor for RFS in our patient.The survival table from the Kaplan-Meier survival analysis revealed that there were significant differences(P <0.001)between subgroups of MPP percentage content in stage ⅠA MPPAC patients and that a higher proportion of MPP was associated with a poorer prognosis.0.5<AUC(0.811)<1 was predictive when intraluminal dissemination and intravascular cancer thrombi occurred in postoperative pathological sections of patients with MPPAC,suggesting a high risk of postoperative recurrence for patients.Conclusion: 1.MPP has influence on malignant degree of tumor.The incidence of visceral pleura infiltration,air cavity dissemination,intravascular tumor thrombi and lymph node metastasis is high in patients with positive MPP.MPP is an independent prognostic factor for stage ⅠA lung adenocarcinoma in clinical stage.2.The clinical and pathological characteristics and prognosis of lung adenocarcinoma with different MPP proportions are different.The survival rate of tumor patients with higher MPP percentages is poorer.With the increase of MPP percentage content,the recurrence risk of patients is significantly increased.The air-cavity dissemination and intravascular cancer thrombi are the independent prognostic factors for MPPAC patients.