{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:21:25Z","timestamp":1758846085609,"version":"3.44.0"},"reference-count":59,"publisher":"BMJ","issue":"4","funder":[{"name":"Donglai Chen","award":["Youth Funding of Zhongshan Hospital (2023ZSQN48)","Youth Funding of Zhongshan Hospital (Residency 202"],"award-info":[{"award-number":["Youth Funding of Zhongshan Hospital (2023ZSQN48)","Youth Funding of Zhongshan Hospital (Residency 202"]}]},{"name":"Yongbing Chen","award":["Hospital of Soochow University (23ZL004)","Hospital of Soochow University (23ZL012)","Key Scientific Program of Jiangsu Provincial Healt","National Natural Science Foundation of China (8217","Suzhou Youth Science and Technology Project of Rev","The Construction Project of High-End Clinical Medi","The Project of Capacity Enhancement of Institution","The Project of Clinical Innovation and Interdiscip"],"award-info":[{"award-number":["Hospital of Soochow University (23ZL004)","Hospital of Soochow University (23ZL012)","Key Scientific Program of Jiangsu Provincial Healt","National Natural Science Foundation of China (8217","Suzhou Youth Science and Technology Project of Rev","The Construction Project of High-End Clinical Medi","The Project of Capacity Enhancement of Institution","The Project of Clinical Innovation and Interdiscip"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2024,7,17]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Conflicting data were provided regarding the prognostic impact and genomic features of lung adenocarcinoma (LUAD) with lepidic growth pattern (LP+A). Delineation of the genomic and immune characteristics of LP+A could provide deeper insights into its prognostic implications and treatment determination.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a search of articles in PubMed, EMBASE and the Cochrane Library from inception to January 2024. A domestic cohort consisting of 52 LUAD samples was subjected to whole-exome sequencing as internal validation. Data from The Cancer Genomic Atlas and the Gene Expression Omnibus datasets were obtained to characterise the genomic and immune profiles of LP+A. Pooled HRs and rates were calculated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The pooled results indicated that lepidic growth pattern was either predominant (0.35, 95% CI 0.22 to 0.56, p&lt;0.01) or minor (HR 0.50, 95% CI 0.36 to 0.70, p&lt;0.01) histological subtype was associated with favourable disease-free survival. Pooled gene mutation rates suggested higher EGFR mutation (0.55, 95% CI 0.46 to 0.64, p&lt;0.01) and lower KRAS mutation (0.14, 95% CI 0.02 to 0.25, p=0.02) in lepidic-predominant LUAD. Lepidic-predominant LUAD had lower tumour mutation burden and pooled positive rate of PD-L1 expression compared with other subtypes. LP+A was characterised by abundance in resting CD4+memory\u2009T cells, monocytes and \u03b3\u03b4 T cells, as well as scarcity of cancer-associated fibroblasts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>LP+A was a unique histological subtype with a higher EGFR mutation rate, lower tumour mutation burden and immune checkpoint expression levels. Our findings suggested potential benefits from targeted therapy over immunotherapy in LP+A.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jcp-2024-209603","type":"journal-article","created":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T13:20:47Z","timestamp":1722691247000},"page":"277-284","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic implications, genomic and immune characteristics of lung adenocarcinoma with lepidic growth pattern"],"prefix":"10.1136","volume":"78","author":[{"given":"Yue","family":"Li","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7603-4803","authenticated-orcid":false,"given":"Donglai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Thoracic 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