Linnoila I
National Cancer Institute-Navy Medical Oncology Branch, Bethesda, Maryland.
Hematol Oncol Clin North Am. 1990 Dec;4(6):1027-51.
Non-small cell lung cancers (NSCLC) comprise 75% of all lung cancers and consist of three major histologic types: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. The histopathology of lung cancer appears to be changing: The incidence of squamous cell carcinoma in the United States is declining, accompanied by the increase in the incidence of adenocarcinoma. Carcinoma of the lung is thought to arise from a pluripotent epithelial cell capable of expressing a variety of phenotypes. Malignant transformation is the end result of multiple events involving the growth control of bronchopulmonary epithelium. It is well known that squamous cell carcinomas are preceded by many years of progressive mucosal changes including squamous metaplasia, dysplasia, and carcinoma in situ. Premalignant changes associated with the other types of NSCLC are less well understood. Recently characterized markers for peripheral airway cell differentiation and selected monoclonal antibodies may be helpful. It is conceivable to identify specific genetic events at the cellular level using in situ hybridization or polymerase chain reaction. Biologic and genetic studies have renewed the awareness of the pleomorphism of NSCLC. Potentially interesting subsets include the following: (1) The expression of neuroendocrine (NE) markers has been demonstrated in selected NSCLC (NSCLC-NE), mostly in adeno- and large cell carcinomas. (2) The presence of K-ras mutations in surgically resected adenocarcinomas has been associated with shortened survival times. (3) Also, the neu gene encoded protein p185 has been associated with a more aggressive clinical course in adenocarcinomas. Further studies are needed to confirm such results and correlate the findings with the current WHO NSCLC classification. Rapid validation of relevant new diagnostic approaches is an enormous challenge. Although selected immunohistochemical and molecular biologic techniques may work on routinely processed paraffin-embedded material obtained from the pathology archives, many of the newest applications require fresh or freshly frozen specimens from large numbers of patients with a computerized clinical data base for adequate clinicopathologic correlations. Establishing such a resource is obviously a team effort requiring close collaboration of the oncologist, pathologist, surgeon, and technicians.
非小细胞肺癌（NSCLC）占所有肺癌的75%，由三种主要组织学类型组成：鳞状细胞癌、腺癌和大细胞癌。肺癌的组织病理学似乎正在发生变化：美国鳞状细胞癌的发病率在下降，同时腺癌的发病率在上升。肺癌被认为起源于能够表达多种表型的多能上皮细胞。恶性转化是涉及支气管肺上皮生长控制的多个事件的最终结果。众所周知，鳞状细胞癌之前有多年的渐进性黏膜变化，包括鳞状化生、发育异常和原位癌。与其他类型NSCLC相关的癌前变化了解较少。最近鉴定的外周气道细胞分化标志物和选定的单克隆抗体可能会有所帮助。使用原位杂交或聚合酶链反应在细胞水平上鉴定特定的基因事件是可行的。生物学和遗传学研究重新唤起了人们对NSCLC多形性的认识。潜在有趣的亚组包括以下几种：（1）在选定的NSCLC（NSCLC-NE）中已证实有神经内分泌（NE）标志物的表达，主要见于腺癌和大细胞癌。（2）手术切除的腺癌中K-ras突变的存在与生存期缩短有关。（3）此外，neu基因编码的蛋白p185与腺癌更具侵袭性的临床病程有关。需要进一步研究来证实这些结果，并将这些发现与当前的世界卫生组织NSCLC分类相关联。快速验证相关的新诊断方法是一项巨大的挑战。尽管选定的免疫组织化学和分子生物学技术可能适用于从病理档案中获得的常规处理的石蜡包埋材料，但许多最新应用需要来自大量患者的新鲜或新鲜冷冻标本以及计算机化临床数据库，以便进行充分的临床病理相关性分析。建立这样一个资源显然需要团队合作，需要肿瘤学家、病理学家、外科医生和技术人员密切协作。
