Invasive mucinous adenocarcinoma of the lung: Serial CT findings, clinical features, and treatment and survival outcomes.
Invasive mucinous adenocarcinoma of the lung: Serial CT findings, clinical features, and treatment and survival outcomes.
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DOI：
10.1111/1759-7714.13674
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发表时间：
2020-12
期刊：
影响因子：
2.9
通讯作者：
Han DH
中科院分区：
文献类型：
--
作者：
Beck KS;Sung YE;Lee KY;Han DH
肺浸润性黏液腺癌是一种少见的腺癌亚型，在电脑断层扫描（CT）上表现为气腔混浊。在日常实践中，我们偶尔会遇到自发消退的空域混浊（SRA）没有治疗的连续CT与IMA患者，这是以前没有在文献中描述。在这里，我们描述了一系列的CT表现，重点是SRA与IMA患者的临床病理特征和治疗结果的关系。共纳入了2013年1月至2018年6月期间经病理学证实的肺部IMA的46例患者。审查了系列CT扫描，并根据是否存在SRA将患者分为SRA和无SRA组。比较SRA组和无SRA组的影像学特征、临床病理学特征和治疗结局。无SRA组共纳入32例患者，SRA组共纳入14例患者。SRA组的IMA多为肺炎型（P < 0.001）、体积较大（P < 0.001）、多灶性（P = 0.001）、CT分期较高（P < 0.001）。在随访期间死亡的7例患者中，6例来自SRA组（P < 0.001）。所有IMA的平均总生存期为86.6个月（范围，0-110个月），SRA组的总生存期明显更差（P < 0.001）。在连续CT上显示SRA的肺IMA较大且多灶性，并且在初始CT上倾向于肺炎类型。患者处于较高的疾病阶段，死亡率较高，总生存期缩短。肺浸润性粘液腺癌（IMA）可在连续CT上显示自发性气道混浊（SRA）消退，与抗癌药物给药无关。显示SRA的IMA显示患者的总生存率降低。当CT显示空域阴影消退时，IMA仍应包括在鉴别诊断中。在评估IMA的肿瘤缓解时，需要更仔细地应用RECIST 1.1。肺浸润性粘液腺癌（IMA）可在连续CT上显示自发消退的气腔混浊（SRA），与抗癌药物给药无关。显示SRA的IMA显示患者的总生存率降低。当CT显示气腔混浊消退时，IMA仍应纳入鉴别诊断，在评估IMA的肿瘤缓解时需要更仔细地应用RECIST 1.1。
Invasive mucinous adenocarcinoma (IMA) of the lung is a rare and distinct subtype of adenocarcinoma that can appear as airspace opacities on computed tomography (CT). In daily practice, we have occasionally encountered spontaneous regression of airspace opacities (SRAs) without treatment on serial CTs in patients with IMAs, which has not previously been described in the literature. Here, we describe serial CT findings with emphasis on SRAs in relation to clinicopathological features and treatment outcomes in patients with IMAs. A total of 46 patients with pathologically‐confirmed IMAs of the lung from January 2013 to June 2018 were included. Serial CT scans were reviewed and the patients were classified into SRA and no‐SRA groups according to the presence of SRA. Radiological features, clinicopathological characteristics, and treatment outcomes were compared between the SRA and no‐SRA groups. A total of 32 patients were included in the no‐SRA group and 14 patients in the SRA group. IMAs in the SRA group were mostly pneumonic (P < 0.001), larger (P < 0.001), multifocal (P = 0.001), and showed higher stage (P < 0.001) on initial CT. Of seven patients who died during follow‐up, six were from the SRA group (P < 0.001). Mean overall survival for all IMAs was 86.6 months (range, 0–110 months), and the SRA group showed significantly worse overall survival (P < 0.001). IMAs of the lung showing SRAs on serial CTs are larger and multifocal, and tend to be pneumonic in type on initial CT. Patients present at a higher stage of disease, with higher mortality rate and reduced overall survival. Invasive mucinous adenocarcinomas (IMAs) of the lung can show spontaneous regression of airspace opacities (SRAs) on serial CTs, without being correlated to the administration of anticancer drugs. IMAs that showed SRAs demonstrated reduced overall survival in patients. When airspace opacities show regression on CT, IMA should still be included in the differential diagnosis. A more careful application of RECIST 1.1 is needed in the assessment of tumor response of IMAs. Invasive mucinous adenocarcinomas (IMAs) of the lung can show spontaneous regression of airspace opacities (SRAs) on serial CTs, not correlated with the administration of anticancer drugs. IMAs that show SRAs demonstrated reduced overall survival in patients. When airspace opacity shows regression on CT, IMA should still be included in the differential diagnosis and a more careful application of RECIST 1.1 is needed in the assessment of tumor response of IMAs.