Clinical Laboratory Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuoku, 104-0045 Tokyo, Japan.
J Thorac Oncol. 2010 Mar;5(3):333-9. doi: 10.1097/JTO.0b013e3181c8cb95.
Lung adenocarcinomas 2 cm or less in diameter were studied to develop histologic criteria predicting the outcome.
We reviewed 510 consecutive lung adenocarcinomas 2 cm or less in diameter and assessed three histologic parameters to implement a histologic scoring system: lymphovascular invasion, maximum diameter of the nonbronchioloalveolar carcinoma (BAC) component, and percentage of the solid, cribriform, and/or papillary component in the entire tumor volume (%solid/cribriform/papillary). One point was given to each of lymphovascular invasion-positive, non-BAC >10 mm and %solid/cribriform/papillary > or =30%, and by the sum of these points, a score of 0 to 3 was assigned for each tumor. We also evaluated minimally invasive adenocarcinomas comprising non-BAC < or =5 mm, Sakurai grades 1 and 2.
Five-year disease-free survival rates of 287 patients with a histologic score of 0, 69 with a score of 1, 64 with a score of 2, and 90 with a score of 3 were 98.9%, 92.4%, 78.4%, and 54.0%, respectively. The 510 tumors included 129 noninvasive and 127 minimally invasive adenocarcinomas. None of these tumors recurred. In remaining 254 patients with overtly invasive adenocarcinomas, 5-year disease-free survival rates in 51 with a histologic score of 0, 49 with a score of 1, 64 with a score of 2, and 90 with a score of 3 were 95.9%, 89.2%, 79.4%, and 54.2%, respectively.
The histologic scoring system comprising lymphovascular invasion-positive, non-BAC >10 mm and %solid/cribriform/papillary > or =30% is able to predict the outcome of lung adenocarcinomas 2 cm or less in diameter not only in all cases but also in overtly invasive adenocarcinomas. Minimally invasive adenocarcinomas did not recur in this large series.
研究直径 2cm 或以下的肺腺癌，以制定预测结局的组织学标准。
我们回顾了 510 例连续的直径 2cm 或以下的肺腺癌，并评估了三个组织学参数，以实施组织学评分系统：淋巴血管侵犯、非细支气管肺泡癌（BAC）成分的最大直径和整个肿瘤体积中实性、筛状和/或乳头状成分的百分比（%实性/筛状/乳头状）。淋巴血管侵犯阳性、非 BAC>10mm 和%实性/筛状/乳头状≥30%的每个病例给予 1 分，每个肿瘤的总分为 0 至 3 分。我们还评估了包括非 BAC<或=5mm、Sakurai 分级 1 和 2 的微浸润性腺癌。
组织学评分 0 分的 287 例患者、评分 1 分的 69 例患者、评分 2 分的 64 例患者和评分 3 分的 90 例患者的 5 年无病生存率分别为 98.9%、92.4%、78.4%和 54.0%。510 例肿瘤包括 129 例非浸润性和 127 例微浸润性腺癌。这些肿瘤均未复发。在其余 254 例有明显浸润性腺癌的患者中，组织学评分 0 分的 51 例患者、评分 1 分的 49 例患者、评分 2 分的 64 例患者和评分 3 分的 90 例患者的 5 年无病生存率分别为 95.9%、89.2%、79.4%和 54.2%。
包含淋巴血管侵犯阳性、非 BAC>10mm 和%实性/筛状/乳头状≥30%的组织学评分系统不仅能够预测所有病例的肺腺癌 2cm 或以下的结局，还能够预测明显浸润性腺癌的结局。在这个大系列中，微浸润性腺癌未复发。
