University Hospital Heidelberg, Heidelberg, Germany.
J Clin Oncol. 2012 May 1;30(13):1438-46. doi: 10.1200/JCO.2011.37.2185. Epub 2012 Mar 5.
Our aim was to analyze and validate the prognostic impact of the novel International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) proposal for an architectural classification of invasive pulmonary adenocarcinomas (ADCs) across all tumor stages.
The architectural pattern of a large cohort of 500 patients with resected ADCs (stages I to IV) was retrospectively analyzed in 5% increments and classified according to their predominant architecture (lepidic, acinar, solid, papillary, or micropapillary), as proposed by the IASLC/ATS/ERS. Subsequently, histomorphologic data were correlated with clinical data, adjuvant therapy, and patient outcome.
Overall survival differed significantly between lepidic (78.5 months), acinar (67.3 months), solid (58.1 months), papillary (48.9 months), and micropapillary (44.9 months) predominant ADCs (P = .007). When patterns were lumped into groups, this resulted in even more pronounced differences in survival (pattern group 1, 78.5 months; group 2, 67.3 months; group 3, 57.2 months; P = .001). Comparable differences were observed for overall, disease-specific, and disease-free survival. Pattern and pattern groups were stage- and therapy-independent prognosticators for all three survival parameters. Survival differences according to patterns were influenced by adjuvant chemoradiotherapy; in particular, solid-predominant tumors had an improved prognosis with adjuvant radiotherapy. The predominant pattern was tightly linked to the risk of developing nodal metastases (P < .001).
Besides all recent molecular progress, architectural grading of pulmonary ADCs according to the novel IASLC/ATS/ERS scheme is a rapid, straightforward, and efficient discriminator for patient prognosis and may support patient stratification for adjuvant chemoradiotherapy. It should be part of an integrated clinical, morphologic, and molecular subtyping to further improve ADC treatment.
我们旨在分析和验证新型国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）提出的浸润性肺腺癌（ADC）的解剖结构分类方案对所有肿瘤分期的预后影响。
回顾性分析了 500 例接受手术治疗的 ADC（I 期至 IV 期）患者的肿瘤结构模式，以 5%的增量进行分析，并根据主要结构（贴壁型、腺泡型、实体型、乳头型或微乳头型）进行分类，这是由 IASLC/ATS/ERS 提出的。随后，组织形态学数据与临床数据、辅助治疗和患者预后相关联。
在总体生存方面，贴壁型（78.5 个月）、腺泡型（67.3 个月）、实体型（58.1 个月）、乳头型（48.9 个月）和微乳头型（44.9 个月）的 ADC 之间存在显著差异（P=0.007）。当将模式分组时，生存差异更为明显（模式组 1，78.5 个月；组 2，67.3 个月；组 3，57.2 个月；P=0.001）。在总生存、疾病特异性生存和无病生存方面也观察到了类似的差异。模式和模式组是所有三个生存参数的独立于分期和治疗的预后预测因子。根据模式的生存差异受到辅助放化疗的影响；特别是，实体型为主的肿瘤接受辅助放疗后预后改善。主要模式与发生淋巴结转移的风险密切相关（P<0.001）。
除了所有最近的分子进展外，根据新型 IASLC/ATS/ERS 方案对肺 ADC 进行的结构分级是患者预后的快速、直接和有效的鉴别因素，并可能支持辅助放化疗的患者分层。它应该成为综合临床、形态和分子分型的一部分，以进一步改善 ADC 的治疗。
