WCLC 2025 - Posters & ePosters-P2.06.02 Invading Through External Elastic Lamina Is Predictive of Poorer Outcomes in Pulmonary Non-Mucinous Invasive Adenocarcinoma

P2.06.02 Invading Through External Elastic Lamina Is Predictive of Poorer Outcomes in Pulmonary Non-Mucinous Invasive Adenocarcinoma

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This study investigated the prognostic significance of tumor invasion through the external elastic lamina (EEL) in pulmonary non-mucinous invasive adenocarcinoma, focusing on the classification of visceral pleural invasion (VPI) into four categories: PL-n (no VPI), PL-i (invasion within internal elastic lamina), PL-e (invasion through external elastic lamina), and PL-p (invasion beyond pleura). The retrospective analysis included 1,217 patients who underwent surgical resection between 2011 and 2016.<br /><br />Results indicated that patients with PL-e exhibited significantly worse outcomes, with 5-year overall survival rates dropping to 71.3%, compared to ~89.7% for PL-n and PL-i. Recurrence-free survival showed a similar pattern, with PL-e at 55.8%. Univariate and multivariate analyses confirmed that invasion through the external elastic lamina (PL-e) was a strong independent predictor of poorer overall and recurrence-free survival. Other factors influencing prognosis included age, angioinvasion, pathological stage, nodal status, and tumor histologic subtype.<br /><br />Importantly, the study provides the first concrete evidence supporting the clinical use of the thickest, outermost external elastic lamina’s involvement as the defining landmark for VPI. This finding validates current guidelines that rely on EEL invasion as a criterion for staging, emphasizing its relevance in prognostication and treatment planning for lung adenocarcinoma.<br /><br />In conclusion, invasion of the external elastic lamina in pulmonary non-mucinous invasive adenocarcinoma is a significant indicator of aggressive tumor behavior and poorer patient outcomes. These results underscore the importance of precise pathological assessment of elastic lamina invasion to improve staging accuracy and guide management in lung cancer patients.

Asset Subtitle

ChiHung Chiang

Meta Tag

Speaker ChiHung Chiang

Topic Pathology and Biomarkers

Keywords

external elastic lamina

visceral pleural invasion

pulmonary non-mucinous invasive adenocarcinoma

PL-e category

prognostic significance

overall survival

recurrence-free survival

tumor invasion

lung adenocarcinoma staging

pathological assessment