Sun Wei, Liu Yu, Liu Xiang-Yang, Lin Dong-Mei, Lv Ning
Department of Pathology, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
Department of Etiology and Carcinogensis, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing, China.
Int J Clin Exp Pathol. 2014 Oct 15;7(11):7583-96. eCollection 2014.
The distinguishing of intrapulmonary metastases from multiple primaries is of great clinical importance. Although comprehensive histological assessment (CHA) was recommended for addressing this problem, the limitations of CHA have been addressed. We hypothesized that a nonmucinous lepidic component with mild nuclear atypia (NLCMA) may be one of the important sign suggesting primary lesions. In this study, we measured the value of NLCMA in distinguishing multiple primaries from intrapulmonary metastases. We retrospectively analyzed a cohort of 54 patients with 116 lesions (70 comparisons). Intrapulmonary metastases and multiple primaries were differentiated on the basis of CHA (Method I) and CHA combined with the assessment of NLCMA (Method II), respectively. Then, the results of two methods were compared with survival analysis. 33 cases were defined as multiple primaries and 21 cases as metastases by Method I, while 41 cases as multiple primaries and 13 cases as metastases by Method II. On univariate analysis, there was a better DFS in patients with a tumor ≤ 3 cm (P=0.012), female gender (P=0.011), highest N0 (P=0.002), absent micropapillary (P=0.013), multiple primaries (P=0.008 by method I, P < 0.001 by method II). A multivariate analysis adjusting for gender, tumor size, micropapillary and multiple primaries/metastases (by methodI and method II, respectively) indicated that multiple primaries (by method II) was an independent predictors for DFS. The presence of NLCMA may indicate that a lesion should be defined as primary in multifocal adenocarcinoma.
区分肺内转移瘤与多个原发性肿瘤具有重要的临床意义。尽管推荐采用全面组织学评估（CHA）来解决这一问题，但CHA的局限性也已得到关注。我们推测具有轻度核异型性的非黏液性鳞屑样成分（NLCMA）可能是提示原发性病变的重要征象之一。在本研究中，我们评估了NLCMA在区分多个原发性肿瘤与肺内转移瘤方面的价值。我们回顾性分析了一组54例患者的116个病灶（70组对照）。分别根据CHA（方法I）以及CHA联合NLCMA评估（方法II）来区分肺内转移瘤和多个原发性肿瘤。然后，通过生存分析比较两种方法的结果。方法I将33例定义为多个原发性肿瘤，21例定义为转移瘤；而方法II将41例定义为多个原发性肿瘤，13例定义为转移瘤。单因素分析显示，肿瘤≤3 cm（P = 0.012）、女性（P = 0.011）、最高N0（P = 0.002）、无微乳头结构（P = 0.013）、多个原发性肿瘤（方法I中P = 0.008，方法II中P < 0.001）的患者无病生存期更好。多因素分析对性别、肿瘤大小、微乳头结构以及多个原发性肿瘤/转移瘤（分别采用方法I和方法II）进行校正后表明，多个原发性肿瘤（采用方法II）是无病生存期的独立预测因素。NLCMA的存在可能表明在多灶性腺癌中一个病灶应被定义为原发性。
