Risk of development of brain metastases according to the IASLC/ATS/ERS lung adenocarcinoma classification in locally advanced and metastatic disease.

INTRODUCTION: Brain metastases (BM) are frequent among lung cancer patients, affecting prognosis and quality of life. The International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS) lung adenocarcinoma (LADC) classification (IASLC/ATS/ERS) has prognostic impact in early-stage disease; however, its role in the advanced setting is not precise. This study aims to determine the correlation between the predominant histological subtype and the risk of developing brain metastases (BM) in locally advanced and metastatic (stages IIIB-IV) LADC. METHODS: A total of 710 patients with LADC were treated at our institution from January 2010 to December 2017. After excluding patients with brain metastases at diagnoses (n = 151), they were categorized according to the IASLC/ATS/ERS LADC classification to estimate the risk of developing brain metastases. A competing risk analysis was employed, considering death a competing risk event. RESULTS: From 559 patients, the mean age was 59 ±â€¯13.2 years, women (52.4 %), and clinical-stage IV (79.2 %). LADC subtypes distribution was lepidic (11.6 %), acinar (37.9 %), papillary (10.2 %), micropapillary (6.8 %), and solid (33.5 %). A total of 27.0 % of patients developed BM, 32.9 % died without brain affection, and 40.0 % did not progress. The predominantly solid subtype showed the greatest probability of all subtypes for developing BM [HR 4.0; 95 % CI (1.80-8.91), p = 0.0006], followed by micropapillary [HR1.11; 95 % CI (0.36-3.39), p = 0.85). The solid subtype, moderately differentiated tumors, age, and ECOG PS (>2) were associated with increased hazards in the multivariate analysis. CONCLUSION: According to the IASLC/ATS/ERS classification, the predominantly solid pattern was significantly associated with an increased risk of developing BM in patients with locally advanced and metastatic LADC. Its prognostic value might help explore novel clinical approaches, modify monitoring for earlier detection, prevent complications, and reduce morbidity.

[Combined hepato-cholangiocarcinoma. Case presentation and literature review]. / Hepato-colangiocarcinoma combinado. Presentación de un caso y revisión de la literatura.

More than 80% of primary liver cancers are hepatocellular carcinoma. The second most frequent primary tumors of the liver are cholangiocarcinomas, accounting for about 15% of primary liver cancers. Less frequent tumor types is the combined hepatocellular-cholangiocarcinoma (CHC), a rare primary liver tumor showing both hepatocellular and bile duct differentiation, and mostly represent less than 5% of primary liver cancer The histogenesis of CHC has been unclear Differentiation potential of hepatocyte and biliar epithelium is closely related to the common embryonic origin and various states of cellular differentiation. Some investigators suggested that CHC originated from intermediate type cells or progenitor cells with dual potential. A rare case of CHC in a 58-year-old female patient is presented. A critical review of the literature discussing clinicopathologic features is also presented.