Invasive features of small-sized lung adenocarcinoma adjoining emphysematous bullae

Gouji Toyokawa, Mototsugu Shimokawa, Yuka Kozuma, Taichi Matsubara, Naoki Haratake, Shinkichi Takamori, Takaki Akamine, Kazuki Takada, Masakazu Katsura, Fumihiro Shoji, Tatsuro Okamoto, Yoshihiko Maehara

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


OBJECTIVES: Radiologically small-sized adenocarcinomas are special entities of lung cancer, as their radiological and pathological invasiveness determines the surgical procedures applied; however, the clinicopathological features of small-sized lung adenocarcinoma adjoining cystic airspaces (Ca-ADJ) have yet to be fully clarified. The aim of this study was to elucidate the clinicopathological characteristics, including the programmed death ligand 1 (PD-L1) expression, in patients with Ca-ADJ < 3.0 cm. METHODS: A total of 283 patients with resected adenocarcinoma, whose radiological tumour size was < 3.0 cm without lymph node or distant metastases on preoperative high-resolution computed tomography, were analysed for their clinicopathological and radiological features. Furthermore, the PD-L1 expression was evaluated by immunohistochemistry using an anti-human PD-L1 rabbit monoclonal antibody (clone SP142). RESULTS: Among the 283 patients, 31 (11.0%) patients were reported to have Ca-ADJ. The Fisher's exact test demonstrated that Ca-ADJ was significantly associated with male gender (P < 0.001), a history of smoking (P < 0.001), a high consolidation/tumour ratio (P = 0.026), advanced pathological stage (P < 0.001), the presence of pleural (P < 0.001) and vessel invasion (P < 0.001), histological invasive subtypes (P < 0.001) and wild-type epidermal growth factor receptor (P = 0.001). The patients with Ca-ADJ had a significantly higher maximum standardized uptake value than those without Ca-ADJ (8.4 vs 4.1, P < 0.001). Furthermore, Ca-ADJ was significantly associated with the PD-L1 expression (P < 0.001). Log-rank test showed that patients with Ca-ADJ had a significantly shorter disease-free survival than those without Ca-ADJ (P = 0.001). CONCLUSIONS: This study showed that patients with radiologically small-sized Ca-ADJ might exhibit radiologically and pathologically invasive features.

Original languageEnglish
Article numberezx295
Pages (from-to)372-378
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number2
Publication statusPublished - Feb 1 2018

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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