Roden Anja C, Yi Eunhee S, Jenkins Sarah M, Edwards Kelly K, Donovan Janis L, Lewis Jean E, Cassivi Stephen D, Marks Randolph S, Garces Yolanda I, Aubry Marie Christine
Departments of *Laboratory Medicine & Pathology ∥Radiation-Oncology Divisions of †Biomedical Statistics and Informatics ‡General Thoracic Surgery §Medical Oncology, Mayo Clinic Rochester, MN.
Am J Surg Pathol. 2015 Apr;39(4):427-41. doi: 10.1097/PAS.0000000000000391.
Data regarding the prognostic significance of the histopathologic classifications of thymic epithelial neoplasms are contradictory, perhaps reflecting issues in reproducibility. We studied the effect of reproducibility of 3 histopathologic classifications on prognosis and investigated the interobserver agreement on invasion and its effect on staging and prognosis. A total of 456 patients who underwent surgery for thymic epithelial neoplasm at Mayo Clinic Rochester (1942 to 2008) were staged (modified Masaoka, proposed Moran, proposed IASLC/ITMIG) and independently classified by 3 thoracic pathologists (World Health Organization, proposed Suster & Moran [S&M], and Bernatz). Interobserver agreement was moderate to substantial for all histopathologic classifications (κ values: 0.65, 0.52, 0.74 for World Health Organization, Bernatz, and S&M, respectively). All histopathologic classifications were significant for overall survival (OS) and disease-free survival (DFS) (all reviewers). If adjusted for Masaoka, only Bernatz classification for one reviewer and all histopathologic classifications for another reviewer were significant for OS. Interobserver agreement for invasion was substantial (κ=0.61) and almost perfect for Masaoka, Moran, and IASLC/ITMIG stage (κ values: 0.85, 0.81, and 0.92, respectively). The correlation coefficient for Masaoka and Moran staging was 0.93. Masaoka and IASLC/ITMIG staging were significant for OS and DFS (all reviewers). If adjusted for any histopathologic classification, Masaoka was significant for OS and DFS (all reviewers). In conclusion, reproducibility of histopathologic classifications has some effect on outcome. S&M is the most reproducible classification. Reproducibility of invasion has no effect on the prognostic value of staging. Masaoka, Moran, and IASLC/ITMIG staging are almost perfectly reproducible. The strong correlation between Masaoka and Moran staging suggests similar prognostic strength.
关于胸腺上皮肿瘤组织病理学分类的预后意义的数据相互矛盾，这可能反映了可重复性方面的问题。我们研究了3种组织病理学分类的可重复性对预后的影响，并调查了观察者间对侵袭的一致性及其对分期和预后的影响。共有456例在梅奥诊所罗切斯特院区（1942年至2008年）接受胸腺上皮肿瘤手术的患者进行了分期（改良马萨oka分期、莫兰提议的分期、国际肺癌研究协会/国际胸腺恶性肿瘤研究组提议的分期），并由3位胸外科病理学家（世界卫生组织、苏斯特和莫兰提议的[S&M]以及贝尔纳茨）进行独立分类。所有组织病理学分类的观察者间一致性为中等至高度（κ值：世界卫生组织、贝尔纳茨和S&M分别为0.65、0.52、0.74）。所有组织病理学分类对总生存期（OS）和无病生存期（DFS）均具有显著意义（所有审阅者）。若根据马萨oka分期进行调整，仅一位审阅者的贝尔纳茨分类以及另一位审阅者的所有组织病理学分类对OS具有显著意义。侵袭的观察者间一致性较高（κ=0.61），而马萨oka、莫兰和国际肺癌研究协会/国际胸腺恶性肿瘤研究组分期的一致性几乎达到完美（κ值分别为0.85、0.81和0.92）。马萨oka和莫兰分期的相关系数为0.93。马萨oka和国际肺癌研究协会/国际胸腺恶性肿瘤研究组分期对OS和DFS均具有显著意义（所有审阅者）。若根据任何组织病理学分类进行调整，马萨oka对OS和DFS均具有显著意义（所有审阅者）。总之，组织病理学分类的可重复性对结果有一定影响。S&M是最具可重复性的分类。侵袭的可重复性对分期的预后价值没有影响。马萨oka、莫兰和国际肺癌研究协会/国际胸腺恶性肿瘤研究组分期几乎具有完美的可重复性。马萨oka和莫兰分期之间的强相关性表明其预后强度相似。
