*Sullivan Nicolaides Pathology, The John Flynn Hospital, Tugun, Queensland, Australia; †The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; ‡Pathology Queensland, The Prince Charles Hospital, Chermside, Queensland, Australia; §School of Medicine, Griffith University, Nathan, Queensland, Australia; ‖Zenith Pathology, Brisbane, Queensland, Australia; ¶Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; #University of Toronto, Toronto, Ontario, Canada; and **Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia.
J Thorac Oncol. 2015 Apr;10(4):673-81. doi: 10.1097/JTO.0000000000000446.
We investigated whether a group of pathologists could reproducibly apply the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification for lung adenocarcinoma to a cohort of stage 1 tumors and whether this architectural classification and/or other parameters could demonstrate survival advantage.
A total of 145 cases of 7 edition of tumor, node, metastasis stage 1 adenocarcinoma were retrospectively reviewed for predominant architectural pattern, including cribriform pattern, nuclear grade, mitotic index, and necrosis. The parameters were assessed for reproducibility and survival and using multivariate analysis, compared with stage, age, and sex.
The majority of tumors had a mixed architecture with the acinar pattern being the most common predominant architecture. Micropapillary and cribriform architecture were the least frequent patterns. This study demonstrated that a group of five pathologists could reproducibly apply the IASLC/ATS/ERS classification. Although there were insufficient cribriform-predominant adenocarcinomas for assessment, when the percentage of all cribriform was combined with other architectures, it was associated with a worse prognosis. The majority of the parameters assessed demonstrated significance with univariate analysis but only mitotic index, as assessed by the highest count/10 high-power fields remained significant with multivariate analysis.
In this study of resected stage 1 primary lung adenocarcinoma, we found mitotic index to be the only independent prognostic marker. It was more closely associated with outcome than either pathologic T stage or IASLC/ATS/ERS architecture-based classification. Further validation of concordance and reproducibility in reporting mitotic index, as well as validation of prognostic significance, needs to be undertaken in independent data sets.
我们研究了一组病理学家是否能够对一组 1 期肿瘤重复应用国际肺癌研究协会/美国胸科学会/欧洲呼吸学会（IASLC/ATS/ERS）肺腺癌分类，以及这种结构分类和/或其他参数是否可以显示生存优势。
回顾性分析了 145 例 7 版肿瘤、淋巴结、转移分期 1 期腺癌，评估主要结构模式，包括筛状模式、核分级、有丝分裂指数和坏死。评估这些参数的重复性和生存，并与分期、年龄和性别进行多变量分析。
大多数肿瘤具有混合结构，其中以腺泡模式最为常见。微乳头状和筛状结构是最不常见的模式。本研究表明，一组 5 名病理学家可以重复应用 IASLC/ATS/ERS 分类。尽管筛状为主的腺癌数量不足，但当所有筛状的百分比与其他结构相结合时，与预后较差相关。评估的大多数参数在单变量分析中具有显著性，但只有最高计数/10 高倍视野的有丝分裂指数在多变量分析中具有显著性。
在这项对切除的 1 期原发性肺腺癌的研究中，我们发现有丝分裂指数是唯一的独立预后标志物。它与结局的相关性比病理 T 分期或基于 IASLC/ATS/ERS 结构的分类更为密切。需要在独立的数据集中进一步验证有丝分裂指数报告的一致性和可重复性，以及预后意义的验证。
