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Distinct Recurrence Pattern and Survival Outcomes of Invasive Mucinous Adenocarcinoma of the Lung: The Potential Role of Local Therapy in Intrapulmonary Spread

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Invasive mucinous adenocarcinoma (IMA) is distinct from non-mucinous adenocarcinoma, but studies on recurrent IMA are scarce. Thus, this study aimed to evaluate the recurrence patterns of IMA and the role of pulmonary local therapy (LT) in resectable pulmonary recurrence of IMA.

Methods

The study reviewed 403 patients with surgically resected IMA between 1998 and 2018. The recurrence patterns were categorized as solitary pulmonary recurrence (SPR), multiple pulmonary recurrence (MPR), and extra-pulmonary recurrence (EPR). The clinicopathologic characteristics, overall survival (OS), and post-recurrence survival (PRS) were analyzed according to the recurrence pattern and LT administration.

Results

Recurrences were found in 91 (22.6%) patients, including 18 patients with SPR, 37 patients with MPR, and 36 patients with EPR. Compared with the MPR and EPR groups, the SPR group had a longer disease-free interval (32.5 vs. 9.6 vs. 10.1 months, respectively; p < 0.01) and a better OS (5-year OS: 88.5%, 41.5%, and 22.9%, respectively; p < 0.01). In case of resectable pulmonary recurrence, pulmonary LT was administered to 15 patients with SPR and 3 patients with MPR. These patients showed a better 5-year PRS than the other patients with pulmonary recurrence (86.3% vs. 30.4%; p < 0.01). Notably, long-term survival was observed for one patient with MPR undergoing LT and two patients with SPR undergoing a second LT for a second pulmonary recurrence.

Conclusions

In this series, the patients with recurrent IMA showed different prognoses according to the recurrence pattern. The patients with pulmonary recurrence of IMA undergoing LT showed a favorable prognosis, suggesting the potential role of LT for resectable pulmonary recurrence of IMA.

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Abbreviations

IMA:

Invasive mucinous adenocarcinoma

KRAS:

Kirsten rat sarcoma virus

LT:

Local therapy

NSCLC:

Non-small cell lung cancer

LVI:

Lymphovascular invasion

VPI:

Visceral pleural invasion

CT:

Computed tomography

PRS:

Post-recurrence survival

SPR:

Solitary pulmonary recurrence

MPR:

Multiple pulmonary recurrence

EPR:

Extra-pulmonary recurrence

RT:

Radiation therapy

OS:

Overall survival

DFI:

Disease-free interval

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Author notes

  1. Dong Woog Yoon and Soohyun Hwang contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Chung-ang University Hospital, Seoul, Korea

    Dong Woog Yoon MD

  2. Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Soohyun Hwang MD & Yoon-La Choi MD, PhD

  3. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Tae Hee Hong MD, PhD, Hong Kwan Kim MD, PhD, Yong Soo Choi MD, PhD, Jhingook Kim MD, Young Mog Shim MD, PhD & Jong Ho Cho MD, PhD

  4. Department of Digital Health, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea

    Tae Hee Hong MD, PhD

  5. Department of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea

    Tae Hee Hong MD, PhD

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  1. Dong Woog Yoon MD
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  2. Soohyun Hwang MD
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  3. Tae Hee Hong MD, PhD
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  4. Yoon-La Choi MD, PhD
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Correspondence to Jong Ho Cho MD, PhD.

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Yoon, D.W., Hwang, S., Hong, T.H. et al. Distinct Recurrence Pattern and Survival Outcomes of Invasive Mucinous Adenocarcinoma of the Lung: The Potential Role of Local Therapy in Intrapulmonary Spread. Ann Surg Oncol 31, 201–212 (2024). https://doi.org/10.1245/s10434-023-14373-8

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  • DOI: https://doi.org/10.1245/s10434-023-14373-8

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