Abstract：
Invasive mucinous lung adenocarcinoma (IMA) has unique radiological findings and pathological characteristics. IMA is classified into solitary and pneumonic types; however, it is unclear whether these are biologically identical.
A single-center retrospective analysis was performed for 70 IMA patients (solitary type [n = 38] and pneumonic type [n = 32]) who underwent pulmonary resection between January 2010 and December 2018. We compared clinical and biological characteristics between the two types.
The frequencies of genetic alternations such as EGFR, KRAS, BRAF, GNAS, ERBB2, TP53, NRG1, and MET were not different. Immunohistochemically, expression of MUC1 was significantly more common in the pneumonic type (5.0% versus 20.0%, p = 0.01) and diffuse MUC6 positive in the solitary type (39.0% versus 13.0%, p = 0.02). We further classified solitary types into those with or without ground-glass opacity (GGO) and pneumonic types into those with or without crazy-paving appearance (CPA), and evaluated their surgical outcomes. Five-year overall survival and relapse free survival rates were 95.8%/86.6%, 64.3%/70.7%, 74.6%/68.9%, and 50.0%/28.6% in patients with solitary type with GGO, solitary type without GGO, pneumonic type without CPA, and pneumonic type with CPA, respectively.
There were no differences in genetic alternations; however, mucin expression pattern was different. Surgical outcomes were different according to the presence of GGO in the solitary type and the presence of CPA in the pneumonic type. These findings suggested a stepwise progression from solitary to pneumonic IMA.
A single-center retrospective analysis was performed for 70 IMA patients (solitary type [n = 38] and pneumonic type [n = 32]) who underwent pulmonary resection between January 2010 and December 2018. We compared clinical and biological characteristics between the two types.
The frequencies of genetic alternations such as EGFR, KRAS, BRAF, GNAS, ERBB2, TP53, NRG1, and MET were not different. Immunohistochemically, expression of MUC1 was significantly more common in the pneumonic type (5.0% versus 20.0%, p = 0.01) and diffuse MUC6 positive in the solitary type (39.0% versus 13.0%, p = 0.02). We further classified solitary types into those with or without ground-glass opacity (GGO) and pneumonic types into those with or without crazy-paving appearance (CPA), and evaluated their surgical outcomes. Five-year overall survival and relapse free survival rates were 95.8%/86.6%, 64.3%/70.7%, 74.6%/68.9%, and 50.0%/28.6% in patients with solitary type with GGO, solitary type without GGO, pneumonic type without CPA, and pneumonic type with CPA, respectively.
There were no differences in genetic alternations; however, mucin expression pattern was different. Surgical outcomes were different according to the presence of GGO in the solitary type and the presence of CPA in the pneumonic type. These findings suggested a stepwise progression from solitary to pneumonic IMA.
摘要：
背景：侵袭性黏液性肺腺癌（IMA）具有独特的影像学表现和病理特征。IMA分为孤立型和肺炎型；然而，目前尚不清楚它们在生物学上是否相同。
方法：对2010年1月至2018年12月期间接受肺切除术的70例IMA患者（孤立型[n=38]和肺炎型[n=32]）进行了单中心回顾性分析。我们比较了两种类型的临床和生物学特征。
结果：基因变异的频率，如EGFR，KRAS,BRAF,GNAS,ERBB2、TP53、NRG1和MET没有差别。免疫组织化学，MUC1的表达在肺炎型中明显更常见(5.0%对20.0%,p=0.01）和孤立型的弥漫性MUC6阳性（39.0％对13.0％，p=0.02)。我们进一步将孤立类型分为有或没有毛玻璃不透明（GGO）的类型，将肺炎类型分为有或没有疯狂铺路外观（CPA）的类型，并评估其手术结果。5年总生存率和无复发生存率分别为95.8%/86.6%,64.3%/70.7%，74.6%/68.9%，孤立型GGO患者为50.0%/28.6%，没有GGO的孤型，无CPA的肺炎型,和带有CPA的肺炎型，分别。
结论：遗传交替没有差异；然而，粘蛋白表达模式不同。根据孤立型中GGO的存在和肺炎型中CPA的存在，手术结果不同。这些发现表明从孤立性到肺炎性IMA的逐步发展。
方法：对2010年1月至2018年12月期间接受肺切除术的70例IMA患者（孤立型[n=38]和肺炎型[n=32]）进行了单中心回顾性分析。我们比较了两种类型的临床和生物学特征。
结果：基因变异的频率，如EGFR，KRAS,BRAF,GNAS,ERBB2、TP53、NRG1和MET没有差别。免疫组织化学，MUC1的表达在肺炎型中明显更常见(5.0%对20.0%,p=0.01）和孤立型的弥漫性MUC6阳性（39.0％对13.0％，p=0.02)。我们进一步将孤立类型分为有或没有毛玻璃不透明（GGO）的类型，将肺炎类型分为有或没有疯狂铺路外观（CPA）的类型，并评估其手术结果。5年总生存率和无复发生存率分别为95.8%/86.6%,64.3%/70.7%，74.6%/68.9%，孤立型GGO患者为50.0%/28.6%，没有GGO的孤型，无CPA的肺炎型,和带有CPA的肺炎型，分别。
结论：遗传交替没有差异；然而，粘蛋白表达模式不同。根据孤立型中GGO的存在和肺炎型中CPA的存在，手术结果不同。这些发现表明从孤立性到肺炎性IMA的逐步发展。
