Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan.
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Lung Cancer. 2015 Nov;90(2):199-204. doi: 10.1016/j.lungcan.2015.06.022. Epub 2015 Jul 2.
We analyzed and validated the prognostic utility of the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) for clinical stage IA lung adenocarcinoma (ADC) classification of adenocarcinoma (ADC).
We retrospectively reviewed 347 patients with clinical stage IA nonmucinous ADC, who had undergone complete resection. The histological subtype was classified according to the predominant subtype, as proposed by the new IASLC/ATS/ERS ADC classification.
The histopathological subtypes, defined according to the new IASLC/ATS/ERS ADC classification, were ADC in situ (AIS) in 56 patients (16.1%), minimally invasive ADC (MIA) in 15 (4.3%), lepidic-predominant ADC in 109 (31.4%), papillary-predominant ADC in 70 (20.2%), acinar-predominant ADC in 61 (17.6%), solid-predominant ADC in 30 (8.6%), and micropapillary-predominant ADC in 6 (1.7%). The 5-year disease-free survival (DFS) rate was 100% for both AIS and MIA. All cases of recurrence involved invasive ADC. The 5-year DFS for lepidic-predominant ADC was 99.0%; acinar-predominant ADC, 82.4%; papillary-predominant ADC, 80.8%; solid-predominant ADC, 73.6%; and micropapillary-predominant ADC, 33.3%. The predominant subtype of ADC was significantly correlated with DFS (P<0.0001). Multivariate analysis indicated that the pathological stage was an independent predictor of DFS (P=0.031). Other independent predictors of increased risk of recurrence were the presence of vascular or lymphatic invasion (HR=4.96, P=0.001), and a pathological stage more advanced than IB (HR=2.87, P=0.010). The coincidence between the clinical stage and pathological stage was 79.8%. The stage migration was found in 53.3% of solid-predominat ADC and in 83.3% of micropapillary-predominant ADC.
The new IASLC/ATS/ERS ADC classification has prognostic value in predicting the recurrence and survival of patients with clinical stage IA ADC. The frequency of stage migration was found in more than half of solid and micropapillary predominant ADCs.
我们分析并验证了新的国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）对临床ⅠA 期肺腺癌（ADC）分类的 ADC 预后效用。
我们回顾性分析了 347 例临床ⅠA 期非黏液性 ADC 患者，这些患者均接受了完全切除术。根据新的 IASLC/ATS/ERS ADC 分类中的主要亚型对组织学亚型进行分类。
根据新的 IASLC/ATS/ERS ADC 分类定义的组织病理学亚型为：原位腺癌（AIS）56 例（16.1%），微浸润腺癌（MIA）15 例（4.3%），贴壁为主型腺癌（lepidic-predominant ADC）109 例（31.4%），乳头为主型腺癌（papillary-predominant ADC）70 例（20.2%），腺泡为主型腺癌（acinar-predominant ADC）61 例（17.6%），实体为主型腺癌（solid-predominant ADC）30 例（8.6%），微乳头为主型腺癌（micropapillary-predominant ADC）6 例（1.7%）。AIS 和 MIA 的 5 年无病生存率（DFS）均为 100%。所有复发病例均为浸润性 ADC。贴壁为主型 ADC 的 5 年 DFS 为 99.0%；腺泡为主型为 82.4%；乳头为主型为 80.8%；实体为主型为 73.6%；微乳头为主型为 33.3%。ADC 的主要亚型与 DFS 显著相关（P<0.0001）。多变量分析表明，病理分期是 DFS 的独立预测因素（P=0.031）。复发风险增加的其他独立预测因素包括血管或淋巴管侵犯（HR=4.96，P=0.001）和病理分期高于 IB（HR=2.87，P=0.010）。临床分期和病理分期的一致性为 79.8%。在 53.3%的实体为主型 ADC 和 83.3%的微乳头为主型 ADC 中发现了分期迁移。
新的 IASLC/ATS/ERS ADC 分类在预测临床ⅠA 期 ADC 患者的复发和生存方面具有预后价值。在超过一半的实体和微乳头为主型 ADC 中发现了分期迁移的情况。
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