A retrospective study of morphologicalprognostic factors in non-small cell lung cancer

Lung cancer has the highest incidence and mortality rates worldwide. A wide range of driver mutations have been identified in the pathogenesis of lung cancer and significant advances have been achieved regarding targeted therapy. However, studies are still conducted to determine the morphological prognostic factors. The aim of this study was to investigate the association of various morphological findings, particularly tumor budding, with prognosis in non-small cell lung carcinoma. Our study included 155 patients with adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma and large cell neuroendocrine carcinoma diagnosed from lung resection materials, between 2014 and 2016 in Bursa Uludag University Faculty of Medicine Pathology Department. Clinicopathological data of the cases were acquired from the electronic hospital files. The slides of the cases were obtained from the pathology archives and tumor budding, histologic type, histologic subtype, necrosis, mitosis, stromal response, stromal inflammatory response, lymphovascular invasion and pleural invasion were evaluated. The relationship between the data obtained and distant metastasis and survival rates were statistically analyzed. According to Cox regression analysis, age (p=0,010), pleural invasion (p=0,028), lymphovascular invasion (p=0,003), necrosis (p=0,010) and stromal inflammatory response (p=0,008) were found to be independent prognostic factors for overall survival. There was a statistically significant v correlation between tumor budding and pathologic stage (p=0,006), diameter (p=0,022), presence of necrosis (p=0,002), mitosis (p=0,022) and stromal inflammatory response (p=0,035) in adenocarcinoma. There was no evident difference between adenocarcinoma subtypes and tumor budding (p=0.055), but tumor budding was observed at a higher rate in solid adenocarcinoma. Statistically significant relationship between morphologic prognostic factors and tumor budding in squamous cell carcinoma were not found. In conclusion, reports of adenocarcinoma and squamous cell carcinoma in routine pathology practices should include tumor budding along with the other prognostic factors.