肺腺癌筛状模式的预后影响和临床病理相关性。

Prognostic impact and clinicopathological correlations of the cribriform pattern in pulmonary adenocarcinoma.

机构信息

*Institute for Pathology, Heidelberg University, Heidelberg, Germany; †Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany; ‡Translational Research Unit, Thoraxklinik at Heidelberg University, Heidelberg, Germany; §Department of Thoracic Surgery, Thoraxklinik at Heidelberg University, Heidelberg, Germany; and ‖National Center for Tumor Diseases (NCT), Heidelberg, Germany.

出版信息

J Thorac Oncol. 2015 Apr;10(4):638-44. doi: 10.1097/JTO.0000000000000490.

DOI:10.1097/JTO.0000000000000490

PMID:25634008

Abstract

BACKGROUND

A novel classification of pulmonary adenocarcinoma (ADC) distinguishing five growth patterns has been established by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society. There is evidence that an additional cribriform pattern associates with a distinct clinical behavior.

METHODS

We evaluated the predominant growth pattern of 674 resected ADC as recommended by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society, including the cribriform pattern. The predominant pattern type was correlated with clinical, molecular, and survival data.

RESULTS

Two hundred forty-eight (36.8%) of the pulmonary ADC were solid, 207 (30.6%) were acinar, 101 (15%) were papillary, 55 (8.2%) were micropapillary, 35 (5.2%) were lepidic, and 28 cases (4.2%) were cribriform predominant (cpADC). Minor cribriform components were frequently observed (28.6% of all cases). cpADC showed the second highest proliferative capacity of all patterns, no somatic mutations in the epidermal growth factor receptor (p = 0.001) and a high rate of KRAS mutations. Overall survival (OS) of patients with cpADC (mean OS: 62.7 months) ranged in between survival times of patients with acinar (mean OS: 71.3 months) and solid predominant ADC (mean OS: 54.5 months); cpADC was associated with the worst disease-free survival (DFS) of all patterns (mean DFS: 36.9 months). Both associations were confirmed by multivariate analysis (p < 0.01 for both OS and DFS). Hazard ratios for cpADC were 1.72 for OS and 2.99 for DFS, with lepidic predominant ADC set as reference (hazard ratio: 1).

CONCLUSIONS

Our data support the introduction of cpADC as a novel category into future morphology based on pulmonary ADC classifications. Further international studies are required to validate the reported clinicopathological associations of the cribriform pattern.

摘要

背景

国际肺癌研究协会/美国胸科学会/欧洲呼吸学会（IASLC/ATS/ERS）建立了一种肺腺癌（ADC）的新型分类方法，可区分五种生长模式。有证据表明，额外的筛状模式与独特的临床行为相关。

方法

我们按照 IASLC/ATS/ERS 的建议评估了 674 例切除的 ADC 的主要生长模式，包括筛状模式。主要模式类型与临床、分子和生存数据相关联。

结果

248 例（36.8%）肺 ADC 为实性，207 例（30.6%）为腺泡型，101 例（15%）为乳头型，55 例（8.2%）为微乳头型，35 例（5.2%）为贴壁为主型，28 例（4.2%）为筛状为主型（cpADC）。在所有病例中，经常观察到少量的筛状成分（28.6%）。cpADC 显示出所有模式中第二高的增殖能力，表皮生长因子受体（EGFR）无体细胞突变（p = 0.001），KRAS 突变率高。cpADC 患者的总生存期（OS）（平均 OS：62.7 个月）介于腺泡型（平均 OS：71.3 个月）和实性为主型 ADC（平均 OS：54.5 个月）之间；cpADC 与所有模式中最差的无病生存期（DFS）相关（平均 DFS：36.9 个月）。这两种关联都通过多变量分析得到证实（OS 和 DFS 的 p 值均<0.01）。cpADC 的风险比（HR）为 OS 时的 1.72 和 DFS 时的 2.99，以贴壁为主型 ADC 为参照（HR：1）。