Department of Thoracic and Vascular Surgery, University (Hospital) Antwerp, Belgium.
Eur J Cardiothorac Surg. 2010 Nov;38(5):628-36. doi: 10.1016/j.ejcts.2010.03.015. Epub 2010 May 7.
Classification of non-small-cell lung cancer (NSCLC) into growth patterns is based on the following question: What does the tumour do with normal lung parenchyma? There are only three possible ways according to which a tumour can behave: (1) preservation of lung tissue and use of its microenvironment for further growth, (2) destruction of lung tissue and formation of new microenvironment for continued expansion and (3) preservation of lung tissue and formation of new microenvironment (modulation). The aim of the current study is to test the prognostic value of growth-pattern classification along with other clinical, pathological and immunohistochemical factors.
Clinicopathological factors of 239 patients operated for NSCLC were retrospectively reviewed. Preoperative smoking status was determined based on two prospectively independent questionnaires. Co-morbidity was determined based on Charlson co-morbidity index (CCI). Haematoxylin-eosin tissue sections were analysed for the determination of tumour growth patterns, histological types, grading, necrosis and desmoplasia. Tumour cell proliferation, endothelial cell proliferation and microvessel density were determined based on double immunostaining with CD34 and Ki67 antibodies. Follow-up data were updated in 2008.
According to the growth-pattern classification, 161 patients (67.4%) had a destructive, 33 (13.8%) a papillary and 45 (18.8%) an alveolar growth pattern. Multiple Cox regression analysis showed that older age (p<0.001), lymph node metastasis (p<0.001), growth-pattern classification (p=0.036) and current smokers (p=0.027) were independent prognostic factors for overall survival. Similar results were obtained for disease-specific and disease-free survival. Papillary (hazard ratio=1.658 and confidence interval=1.001-2.748, p=0.050) and alveolar (hazard ratio=2.056 and confidence interval=1.305-3.237, p=0.002) growth patterns were independent predictors of early recurrence.
Growth-pattern classification remains a significant prognostic factor in NSCLC providing a possible explanation for survival differences in the same disease stage.
非小细胞肺癌（NSCLC）的生长模式分类基于以下问题：肿瘤对正常肺实质的影响如何？根据肿瘤的三种可能行为方式，可分为以下三种：（1）保留肺组织并利用其微环境进一步生长；（2）破坏肺组织并形成新的微环境以继续扩张；（3）保留肺组织并形成新的微环境（调节）。本研究旨在测试生长模式分类与其他临床、病理和免疫组织化学因素的预后价值。
回顾性分析 239 例 NSCLC 手术患者的临床病理因素。术前吸烟状况根据两份前瞻性独立问卷确定。共病根据 Charlson 共病指数（CCI）确定。苏木精-伊红组织切片用于确定肿瘤生长模式、组织学类型、分级、坏死和纤维变性。肿瘤细胞增殖、内皮细胞增殖和微血管密度根据 CD34 和 Ki67 抗体的双重免疫染色确定。2008 年更新随访数据。
根据生长模式分类，161 例（67.4%）患者为破坏性生长，33 例（13.8%）为乳头状生长，45 例（18.8%）为肺泡生长模式。多因素 Cox 回归分析显示，年龄较大（p<0.001）、淋巴结转移（p<0.001）、生长模式分类（p=0.036）和当前吸烟者（p=0.027）是总生存的独立预后因素。疾病特异性和无病生存率也得到了类似的结果。乳头状（危险比=1.658，置信区间=1.001-2.748，p=0.050）和肺泡（危险比=2.056，置信区间=1.305-3.237，p=0.002）生长模式是早期复发的独立预测因素。
生长模式分类仍然是非小细胞肺癌的一个重要预后因素，为同一疾病阶段的生存差异提供了可能的解释。
