The ratio of cancer cells to stroma within the invasive area is a histologic prognostic parameter of lung adenocarcinoma

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 118; pp. 30 - 35
• Main Authors: Ichikawa, Tomohiro, Aokage, Keiju, Sugano, Masato, Miyoshi, Tomohiro, Kojima, Motohiro, Fujii, Satoshi, Kuwata, Takeshi, Ochiai, Atsushi, Suzuki, Kenji, Tsuboi, Masahiro, Ishii, Genichiro
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.04.2018
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Cancer cell ratio; Elastic fiber; Elastic Tissue - pathology; Female; Humans; Invasive area; Lung adenocarcinoma; Lung Neoplasms - diagnosis; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Paraffin Embedding; Predictive Value of Tests; Prognosis; Stromal Cells - pathology; Survival Analysis; Tumor Microenvironment; Elastic fiber; Invasive area; Prognosis; Lung adenocarcinoma; Cancer cell ratio
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2018.01.023

•Low proportion of cancer cells in the invasive area had better prognosis.•This was associated with the greater proportion of VVG-positive elastic fibers.•The character of the invasive area could be a useful histologic prognostic parameter. This study evaluated whether the proportion of cancer cells to non-cancerous stroma within the invasive area is associated with the prognosis of patients with lung adenocarcinoma. A total of 127 patients with lung adenocarcinomas with tumors larger than 3 cm in total size were enrolled in this study. We classified the tumors according to the ratio of area occupied by cancer cells within the invasive area (Type A: more than 50% of the invasive area, Type B: 10–50%, and Type C: less than 10%) and analyzed the clinicopathological differences between Types A, B, and C. The invasive size of Type A tumors (n = 35) was significantly larger than those of the other two tumor types; however, there was no significant difference in the invasive size between Types B (n = 65) and C (n = 25) tumors. The recurrence-free survival time of patients with Type C tumors was significantly longer than those of patients with Type A and B (P < .001) tumors. Multivariate analysis revealed that Type C tumor was an independent favorable prognostic factor (P = .037) but that invasive size was not. The invasive area of Type C tumor was composed of a significantly higher proportion of collapsed elastic fibers than the invasive areas of Type A and B tumors (P < .001). A lower cancer cell to stroma ratio within the invasive area could be a significant prognostic factor in lung adenocarcinoma, suggesting that not only the invasive size but also the invasive character might be an important histologic prognostic parameter.