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PUB049 Distinct Clinical Characteristics of Lung Adenocarcinoma Correlate with Its Histologic Patterns
S1476
Journal of Thoracic Oncology
Methods: Patient characteristics are shown in table 1. We evaluated tumor burden, the presence of tumor infiltrating lymphocytes (TIL), and type of lung injury. TIL were quantitated using a 4 tier system (0-3+ ¼ none; mild, moderate, extensive). Table 1. Summary of demographic and clinical information Case
Immune Age Sex Tx Pneumonitis Chest Imaging
1 2
38 65
WM WM
3 mo 9 mo
Yes No
3
54
WF
Yes
4 5
30 59
BM WM
single dose 4 mo 7 mo
6
72
WM
25 mo
Yes
7
68
WM
5 mo
Yes
GGO, multifocal Bilateral pleural effusion Bilateral reticular opacities GGO, patchy Pulmonary emboli and tumor GGO, bilateral, diffuse GGO, bilateral, diffuse
No No
Results: Residual viable tumor with little or no therapy effects was present in all 7 cases. The 4 cases where pneumonitis was diagnosed clinically all had at least focal DAD. The majority of tumors had at least scattered TIL present, while one tumor had a large number TIL. Table 2. Summary of autopsy findings Tumor
1
ACA in 5 1+ lobes MM in LLL, 3+ LUL ACA in 4 1+ lobes
Yes* Focal
No
<5%
No
No
None
MM in 4 lobes MM in RUL SCC in RLL, LLL, LUL SCC in 5 lobes
1+
Yes
1+ 2+
No Yes
1+
Yes
2 3
4 5 6
7
TIL LVI
Yes
DAD
Tumor Pneumonia necrosis
Case
Focal RLL LUL, RUL, LLL No No RUL, RML, RLL LUL, LLL
LLL RLL LUL None
No
None
No No
None 10% and fibrosis
No
20-30%
ACA: adenocarcinoma; MM: Malignant melanoma; SCC: squamous cell carcinoma; *extensive LVI
Conclusion: The majority of patients with clinical diagnosis of pneumonitis did have DAD at autopsy and variable amount of viable tumor in the lungs and at least a few tumor infiltrating lymphocytes. Additional studies are pending the further characterize the phenotype of the TIL and to determine PD1 and PDL1 expression on the tumor cells.
Vol. 12 No. 1S
Keywords: Autopsy, lung pathology, Therapy, Immune checkpoint
PUB049 Distinct Clinical Characteristics of Lung Adenocarcinoma Correlate with Its Histologic Patterns Yue Cheng,1 Zhixin Qiu,2 Ping Zhou,1 Dan Liu,2 Weimin Li2 1West China School of Medicine, west China Hospital, sichuan University, Chengdu,sichuan/China, 2 West China Hospital, sichuan University, Chengdu,sichuan/China Background: A novel classification system based on architecture and associated with prognosis has been proposed for pulmonary adenocarcinoma (ADC) by International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) in 2011. Here, we evaluated the relationship between clinical characteristics and its histologic patterns. Methods: 400 resected invasive lung ADCs in West China Hospital from 2008 to 2014 were analyzed in 5% increments and classified according to their predominant patterns, as proposed by the IASLC/ATS/ERS. Pleural invasion, angio-lymphatic invasion, tumor necrosis, lymph node metastasis, cell differentiation were recorded. Clinical data,including gender, age at diagnosis, smoking status, family history, and TNM stage were also collected. Results: In the total 400 cases, there were 194 acinar predominant ADCs (APA,48.5%), 85 lepidic predominant ADCs (LPA,21.2%), 65 papillary predominant ADCs (PPA,16.2%), 51 solid predominant ADCs (SPA,12.8%), 5 micro-papillary ADCs (MIA,1.2%). 95.0% were with mixed growth patterns. Univariate analysis showed that ADC subtypes were significantly associated with sex (p¼0.037), tumor diameter (p<0.001), pleural invasion (p¼0.001), tumor necrosis (p<0.001), cell differentiation (p<0.001), lymph node metastasis (p¼0.003), TNM stage (p<0.05) and smoking history (p¼0.001). Multivariate analysis concluded that ADC subtypes were correlated with pleural invasion (p¼0.014) and cell differentiation (p<0.001) significantly. Conclusion: Invasive lung ADC subtypes classified according to the IASLC/ERS/ATS proposal are closely correlated with distinctive clinical characteristics,which may offer the basis for the development of individualized strategies for lung ADC sufferers. Keywords: pulmonary adenocarcinoma, histology, subtyping, clinical characteristics
Journal of Thoracic Oncology
Methods: Patient characteristics are shown in table 1. We evaluated tumor burden, the presence of tumor infiltrating lymphocytes (TIL), and type of lung injury. TIL were quantitated using a 4 tier system (0-3+ ¼ none; mild, moderate, extensive). Table 1. Summary of demographic and clinical information Case
Immune Age Sex Tx Pneumonitis Chest Imaging
1 2
38 65
WM WM
3 mo 9 mo
Yes No
3
54
WF
Yes
4 5
30 59
BM WM
single dose 4 mo 7 mo
6
72
WM
25 mo
Yes
7
68
WM
5 mo
Yes
GGO, multifocal Bilateral pleural effusion Bilateral reticular opacities GGO, patchy Pulmonary emboli and tumor GGO, bilateral, diffuse GGO, bilateral, diffuse
No No
Results: Residual viable tumor with little or no therapy effects was present in all 7 cases. The 4 cases where pneumonitis was diagnosed clinically all had at least focal DAD. The majority of tumors had at least scattered TIL present, while one tumor had a large number TIL. Table 2. Summary of autopsy findings Tumor
1
ACA in 5 1+ lobes MM in LLL, 3+ LUL ACA in 4 1+ lobes
Yes* Focal
No
<5%
No
No
None
MM in 4 lobes MM in RUL SCC in RLL, LLL, LUL SCC in 5 lobes
1+
Yes
1+ 2+
No Yes
1+
Yes
2 3
4 5 6
7
TIL LVI
Yes
DAD
Tumor Pneumonia necrosis
Case
Focal RLL LUL, RUL, LLL No No RUL, RML, RLL LUL, LLL
LLL RLL LUL None
No
None
No No
None 10% and fibrosis
No
20-30%
ACA: adenocarcinoma; MM: Malignant melanoma; SCC: squamous cell carcinoma; *extensive LVI
Conclusion: The majority of patients with clinical diagnosis of pneumonitis did have DAD at autopsy and variable amount of viable tumor in the lungs and at least a few tumor infiltrating lymphocytes. Additional studies are pending the further characterize the phenotype of the TIL and to determine PD1 and PDL1 expression on the tumor cells.
Vol. 12 No. 1S
Keywords: Autopsy, lung pathology, Therapy, Immune checkpoint
PUB049 Distinct Clinical Characteristics of Lung Adenocarcinoma Correlate with Its Histologic Patterns Yue Cheng,1 Zhixin Qiu,2 Ping Zhou,1 Dan Liu,2 Weimin Li2 1West China School of Medicine, west China Hospital, sichuan University, Chengdu,sichuan/China, 2 West China Hospital, sichuan University, Chengdu,sichuan/China Background: A novel classification system based on architecture and associated with prognosis has been proposed for pulmonary adenocarcinoma (ADC) by International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) in 2011. Here, we evaluated the relationship between clinical characteristics and its histologic patterns. Methods: 400 resected invasive lung ADCs in West China Hospital from 2008 to 2014 were analyzed in 5% increments and classified according to their predominant patterns, as proposed by the IASLC/ATS/ERS. Pleural invasion, angio-lymphatic invasion, tumor necrosis, lymph node metastasis, cell differentiation were recorded. Clinical data,including gender, age at diagnosis, smoking status, family history, and TNM stage were also collected. Results: In the total 400 cases, there were 194 acinar predominant ADCs (APA,48.5%), 85 lepidic predominant ADCs (LPA,21.2%), 65 papillary predominant ADCs (PPA,16.2%), 51 solid predominant ADCs (SPA,12.8%), 5 micro-papillary ADCs (MIA,1.2%). 95.0% were with mixed growth patterns. Univariate analysis showed that ADC subtypes were significantly associated with sex (p¼0.037), tumor diameter (p<0.001), pleural invasion (p¼0.001), tumor necrosis (p<0.001), cell differentiation (p<0.001), lymph node metastasis (p¼0.003), TNM stage (p<0.05) and smoking history (p¼0.001). Multivariate analysis concluded that ADC subtypes were correlated with pleural invasion (p¼0.014) and cell differentiation (p<0.001) significantly. Conclusion: Invasive lung ADC subtypes classified according to the IASLC/ERS/ATS proposal are closely correlated with distinctive clinical characteristics,which may offer the basis for the development of individualized strategies for lung ADC sufferers. Keywords: pulmonary adenocarcinoma, histology, subtyping, clinical characteristics