Nakagiri Tomoyuki, Sawabata Noriyoshi, Morii Eiichi, Inoue Masayoshi, Shintani Yasushi, Funaki Soichiro, Okumura Meinoshin
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5), Yamadaoka, Suita, Osaka, 565-0871, Japan,
Gen Thorac Cardiovasc Surg. 2014 Nov;62(11):671-7. doi: 10.1007/s11748-014-0429-3. Epub 2014 Jun 3.
The International association for the study of cancer (IASLC)/American thoracic society (ATS)/European respiratory society (ERS) has established a new subclassification of lung adenocarcinoma, especially for the lepidic pattern component, formerly called bronchioloalveolar adenocarcinoma (BAC). According to the new classification, BAC has been classified into the following 4 main subtypes: adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA), and variants of invasive adenocarcinoma (VIA). An observational study was conducted to validate this classification in patients with pathological stage IA pulmonary adenocarcinoma.
147 patients treated for pathological stage IA lung adenocarcinoma by complete resection at Osaka University Medical Hospital from January 1993 to December 2002 were assessed. The tumor specimens of the cohort were classified into the 4 subgroups. In addition, these groups were compared for various prognostic factors.
Adenocarcinoma in situ was observed in 30 patients, MIA in 8, IA in 104, and VIA in 5 patients, with 5-year survival rates of 100, 100, 85.5, and 60.0 %, respectively. The relationship between the histological classification and K-ras mutation was significant (p < 0.001), especially when comparing the VIA group with the others (p ≪ 0.001). Ki67-labeling indices were significantly different between the AIS and IA groups (p = 0.040).
This study validated the proposed IASLC/ATS/ERS classification for pulmonary adenocarcinoma in patients with pathological stage IA pulmonary adenocarcinoma. The difference between AIS and IA may depend on the proliferation of the carcinoma. In addition, the difference between VIA and the other adenocarcinoma types may depend on genetic factors, especially K-ras mutations.
国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）已建立了肺腺癌的新分类，特别是针对以前称为细支气管肺泡腺癌（BAC）的鳞屑样生长模式成分。根据新分类，BAC已被分为以下4种主要亚型：原位腺癌（AIS）、微浸润腺癌（MIA）、浸润性腺癌（IA）和浸润性腺癌变异型（VIA）。进行了一项观察性研究以验证该分类在病理分期为IA期的肺腺癌患者中的有效性。
评估了1993年1月至2002年12月在大阪大学医学医院接受病理分期为IA期肺腺癌完全切除术治疗的147例患者。该队列的肿瘤标本被分为4个亚组。此外，对这些组的各种预后因素进行了比较。
30例患者观察到原位腺癌，8例为微浸润腺癌，104例为浸润性腺癌，5例为浸润性腺癌变异型，5年生存率分别为100%、100%、85.5%和60.0%。组织学分类与K-ras突变之间的关系具有显著性（p<0.001），特别是将VIA组与其他组进行比较时（p≪0.001）。AIS组和IA组之间的Ki67标记指数有显著差异（p = 0.040）。
本研究验证了IASLC/ATS/ERS对病理分期为IA期的肺腺癌患者提出的分类。AIS和IA之间的差异可能取决于癌的增殖。此外，VIA与其他腺癌类型之间的差异可能取决于遗传因素，尤其是K-ras突变。
