Clinicopathologic features and prognostic significance of lung tumours with mixed histologic patterns

Our plain-English summary of Clinicopathologic features and prognostic significance of lung tumours with mixed histologic patterns, by E. Cakir, E. Demirag, M. Aydin, et al (Acta Chirurgica Belgica, 2009).

The study

• Authors: E. Cakir, E. Demirag, M. Aydin, E. Unsal
• Journal: Acta Chirurgica Belgica
• Published: 2009;109(4):489-93
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Lung tumours with a mixed histologic pattern are rare. We evaluated the clinicopathologic features and prognosis of lung tumours with mixed histology and compared them with the tumours which have single histology. The study group consisted of 39 patients with a mixed histologic pattern and a control group consisted of 41 patients with a single histology on the consecutive surgical specimens. In the study group three types of tumour were identified: adenosquamous carcinoma, combined neuro-endocrine tumours and biphasic tumours. The combined neuro-endocrine tumours were further divided into small cell carcinoma (SCLC)+non-neuro-endocrine carcinoma (NNEC), SCLC+large cell neuro-endocrine carcinoma (LCNEC) and LCNEC +NNEC. Clinicopathologic characteristics, stage and survival rates were evaluated retrospectively and compared with the tumours showing single histology. There was no significant difference in mean age, sex, smoking history, asbestos exposure and tumour size between the study and control groups (p > 0.05). Among adenosquamous carcinomas advanced stage (IIIa or IIIb) (p = 0.004), vascular invasion (p = 0.04) and parietal pleural involvement (p = 0.012) was significantly more evident than in the single histology group. Among combined neuro-endocrine tumours, advanced stages (p = 0.002) and vascular invasion (p = 0.003) were more evident than in the single histology group. Two- year survival rates were 60% for the single histology group, 39% for the adenosquamous group and 25% for the combined neuro-endocrine tumour group (p = 0.0002). Tumours with mixed histology are rarely seen in the lung. Among these tumours adenosquamous carcinoma and combined neuro-endocrine tumours present more aggressive clinico-pathologic behaviour than tumors with a single histology.

In plain English

This study, from a chest hospital in Ankara, Turkey, looked back at lung cancers that showed two different tissue types under the microscope ('mixed histology'). It compared them with lung cancers of a single tissue type. All patients had surgery intended to cure the cancer. The mixed group had 39 patients: 20 with adenosquamous carcinoma, 16 with combined neuro-endocrine tumours and 3 with biphasic tumours (carcinosarcoma). The comparison group had 41 patients with single-type adenocarcinoma or squamous cell carcinoma. The abstract states that the groups did not differ significantly in age, sex, smoking history, asbestos exposure or tumour size. The article gives no asbestos figures and does not say how exposure was assessed. Compared with the single-type group, adenosquamous and combined neuro-endocrine tumours were more often at an advanced stage and more often showed vascular invasion. Two-year survival was 60% in the single-type group, 39% in the adenosquamous group and 25% in the combined neuro-endocrine group. The authors concluded that these two mixed types behave more aggressively than single-type tumours.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective comparison of surgical lung tumour specimens (mixed histology study group versus a single histology control group) at one hospital
• Who was studied: Patients operated on with curative intent for bronchogenic carcinoma from 2000 to 2003 at Ankara Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Turkey. The study group was 39 patients with two histologic types (20 adenosquamous carcinoma, 16 combined neuro-endocrine tumours, 3 biphasic tumours). The control group was 41 consecutive patients operated on in 2000 to 2001 (15 adenocarcinomas, 26 squamous cell carcinomas).
• Exposure: The study compared tumour tissue types, not an exposure. Asbestos exposure appears only in the abstract, as one of the characteristics compared between groups. The article gives no fiber types, sources, doses or figures for it.
• Main results:
  • Adenosquamous carcinoma group: advanced stage (IIIa or IIIb) was significantly more common than in the single histology group (p = 0.004). Stage III was 9 of 20 (45%) versus 12 of 41 (29.3%).
  • Adenosquamous carcinoma group compared with the single histology group: vascular invasion was 8 (40%) versus 3 (7.3%), p = 0.04. Parietal pleural involvement was 6 (30%) versus 2 (4.9%), p = 0.012.
  • Combined neuro-endocrine tumour group compared with the single histology group: advanced stage was more common (p = 0.002; stage III 9, or 56.3%). Vascular invasion was more common: 7 (43.8%) versus 3 (7.3%), p = 0.003.
  • Two-year survival was 60% for the single histology group, 39% for the adenosquamous group and 25% for the combined neuro-endocrine tumour group (p = 0.0002).
  • Across all groups, univariate analysis found tumour stage (p = 0.016) and visceral pleural involvement (p = 0.018) significantly associated with survival.
  • Biphasic tumours (3 patients): median survival was 21 months.
• The authors' conclusion: The authors concluded that, among lung tumours with mixed histology, adenosquamous carcinoma and combined neuro-endocrine tumours show more aggressive clinico-pathologic behaviour than tumours with a single histology.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Prognosis, Histology, Carcinoma, Biphasic Mesothelioma, Asbestos Exposure.

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