影响非小细胞肺癌特定病理诊断的因素。

Factors influencing a specific pathologic diagnosis of non-small-cell lung carcinoma.

机构信息

Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

Clin Lung Cancer. 2013 May;14(3):238-44. doi: 10.1016/j.cllc.2012.11.004. Epub 2013 Jan 4.

DOI:10.1016/j.cllc.2012.11.004

PMID:23291255

Abstract

INTRODUCTION

Historically, a non-small-cell lung carcinoma diagnosis, without pathologic subclassification, provided sufficient information to guide therapy. Evidence now demonstrates that pathologic subtype classification is central in selecting optimal treatment. This review aimed to identify factors associated with a specific pathologic diagnosis.

METHODS

All nonoperative cases of non-small-cell lung carcinoma (NSCLC) referred to the medical oncology divisions of the Ottawa Hospital Cancer Centre (2008) and Princess Margaret Hospital, Toronto (2007-2010) were identified. The charts were reviewed for demographics, diagnostic methods, and final diagnosis. Logistic regression was performed to identify variables associated with a specific diagnosis.

RESULTS

Of 739 patient records analyzed, 377 (51%) were men, 299 (40%) were aged over 70 years, and 510 (69%) had an Eastern Cooperative Oncology Group performance status of 0-2. Three hundred and eighty five (52%) of patients were diagnosed in a tertiary academic center. The lung primary was sampled in 503 (68%) of patients. Computed tomography-guided biopsy (n = 370, 50%) and bronchoscopy (n = 179, 24%) were the most common techniques. Four hundred and seventy seven (65%) of biopsies were cytologic specimens alone, and immunohistochemistry was performed in 337 (46%) of cases. The most common diagnoses were adenocarcinoma (n = 338, 46%), NSCLC not otherwise specified (n = 254, 34%), and squamous cell carcinoma (n = 115, 16%). Overall, 456 (62%) of patients received a specific pathologic diagnosis. Factors significantly associated with attaining a specific pathologic diagnosis were diagnosis outside an academic center (adjusted odds ratios [OR] 2.1 [95% CI, 1.41-3.14]; P = .0003), histologic laboratory samples (adjusted OR 1.58 [95% CI, 1.003-2.49]; P = .049), and immunohistochemical testing (adjusted OR 1.82 [95% CI, 1.25-2.70], P = .0021).

CONCLUSIONS

A significant minority of patients with NSCLC do not receive a specific pathologic diagnosis. In an era of individualized medicine, this may potentially impact optimal clinical management.

摘要

简介

从历史上看，非小细胞肺癌的诊断如果没有病理亚分类，就足以提供指导治疗的信息。目前的证据表明，病理亚型分类是选择最佳治疗方法的关键。本综述旨在确定与特定病理诊断相关的因素。

方法

检索 2008 年渥太华医院癌症中心和 2007-2010 年多伦多玛格丽特公主医院的所有非小细胞肺癌（NSCLC）非手术病例。查阅图表以了解患者的人口统计学、诊断方法和最终诊断。使用逻辑回归确定与特定诊断相关的变量。

结果

在分析的 739 份患者记录中，377 名（51%）为男性，299 名（40%）年龄超过 70 岁，510 名（69%）的东部合作肿瘤学组表现状态为 0-2。385 名（52%）患者在三级学术中心诊断。503 名（68%）患者的肺部原发性病变被取样。CT 引导下活检（n = 370，50%）和支气管镜检查（n = 179，24%）是最常见的技术。477 份（65%）活检仅为细胞学标本，337 份（46%）进行了免疫组织化学检查。最常见的诊断是腺癌（n = 338，46%）、非小细胞肺癌未另作说明（n = 254，34%）和鳞状细胞癌（n = 115，16%）。总体而言，456 名（62%）患者获得了明确的病理诊断。与获得明确病理诊断显著相关的因素包括在学术中心以外诊断（调整后的优势比[OR] 2.1 [95%CI，1.41-3.14]；P =.0003）、组织学实验室样本（调整后的 OR 1.58 [95%CI，1.003-2.49]；P =.049）和免疫组织化学检测（调整后的 OR 1.82 [95%CI，1.25-2.70]，P =.0021）。