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The histological classification of lung adenocarcinoma is one of the greatest challenges due to the significant neoplastic heterogeneity.In 2011,the International Association for the Study of Lung Cancer(IASLC),the American Thoracic Society(ATS),and the European Respiratory Society(ERS)published a new international multidisciplinary lung adenocarcinoma classification.Few single-center studies to date have assessed prognostic and clinical relevance of the new proposed classification.With this aim,we investigated patient survival in a series of 317 Chinese patients with stage I lung adenocarcinoma.According to the new classification,papillary predominant adenocarcinoma is the most common subtype in Chinese patients(36.9%,117/317).Although lepidic predominant adenocarcinomas(LPA)are associated with favorable survival,once the invasive components surpassed the lepidic component,the prognosis becomes poor.Enteric adenocarcinoma was relatively rare,but the prognosis was very poor and therefore belonged to a high-risk group.The disease-free survival(DFS)analysis showed significant difference among all predominant histological subtypes(p=0.017)and groups based on the low,intermediate and high-risk grade(p<0.001).The independent significant factors include older age(p<0.05),larger tumor size(p<0.01),higher grade(p<0.001),higher stage(p<0.01)and intratumoral vascular invasion(p< 0.05).In multivariate analysis,tumor-risk grade and stage were important determinants of the survival(HR=2.02,p=0.001 and HR=1.95,p=0.013,respectively).In conclusion,the clinical and prognostic relevance of multiform histological patterns was confirmed in a series of stage I lung adenocarcinoma patients from China.