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dc.contributor.authorSereno, Marco
dc.contributor.authorHe, Zhangyi
dc.contributor.authorSmith, Claire R
dc.contributor.authorBaena, Juvenal
dc.contributor.authorDas, Madhumita
dc.contributor.authorHastings, Robert K
dc.contributor.authorRake, Grace
dc.contributor.authorFennell, Dean A
dc.contributor.authorNakas, Apostolos
dc.contributor.authorMoore, David A
dc.contributor.authorLe Quesne, John
dc.date.accessioned2021-04-20T08:30:10Z
dc.date.available2021-04-20T08:30:10Z
dc.date.issued2021-02-07
dc.date.submitted2020-06-08
dc.identifier.issn0309-0167
dc.identifier.issn1365-2559
dc.identifier.otherhis14301
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/321332
dc.description.abstractAims: 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.
dc.languageen
dc.subjectOriginal Article
dc.subjectOriginal Articles
dc.subjectadenocarcinoma of lung
dc.subjectadjuvant
dc.subjectbiomarkers
dc.subjectchemotherapy
dc.subjecthistology
dc.subjecttumour
dc.titleInclusion of multiple high‐risk histopathological criteria improves the prediction of adjuvant chemotherapy efficacy in lung adenocarcinoma
dc.typeArticle
dc.date.updated2021-04-20T08:30:09Z
prism.endingPage848
prism.issueIdentifier6
prism.publicationNameHistopathology
prism.startingPage838
prism.volume78
dc.identifier.doi10.17863/CAM.68455
dcterms.dateAccepted2020-11-04
rioxxterms.versionofrecord10.1111/his.14301
rioxxterms.versionAO
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidSereno, Marco [0000-0003-4573-9303]
dc.contributor.orcidHe, Zhangyi [0000-0002-5609-8962]
dc.contributor.orcidSmith, Claire R [0000-0002-6401-2014]
pubs.funder-project-idMedical Research Council (RG94521)


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