新国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）分类中基于模式的分级系统对亚洲Ⅰ期肺腺癌患者的预后影响
Prognostic impact of pattern-based grading system by the new IASLC/ATS/ERS classification in Asian patients with stage I lung adenocarcinoma.
作者信息
Zhao Ze-Rui, Xi Shao-Yan, Li Wei, Situ Dong-Rong, Chen Ke-Ming, Yang Han, Su Xiao-Dong, Lin Yong-Bin, Long Hao
机构信息
State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China; Lung Cancer Research Center, Sun Yat-Sen University, Guangzhou, China; Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, and Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
出版信息
Lung Cancer. 2015 Dec;90(3):604-9. doi: 10.1016/j.lungcan.2015.10.026. Epub 2015 Nov 4.
OBJECTIVES
We examined the prognostic effect of the grading system based on the new IASLC/ATS/ERS classification in an Asian cohort of patients with early-stage lung adenocarcinoma.
MATERIALS AND METHODS
Patients with a lung adenocarcinoma less than 3cm in diameter that had undergone complete anatomic resection, diagnosed with pT1a-2aN0M0 consecutively from 2004 to 2013, were enrolled. All specimens were reviewed according to the new IASLC/ATS/ERS classification. The growth patterns were divided into three major categories: grade 1 for lepidic growth, grade 2 for acinar and papillary patterns, and grade 3 for solid and micropapillary patterns. Each tumor was then graded according to the modified grading system, the final score being the sum of the two most predominant grades. The correlations of clinical and pathological factors with disease-free survival (DFS) and overall survival (OS) were evaluated.
RESULTS
In total, 201 adenocarcinomas were eligible for score grading. Only 37 (18.4%) patients had a pure pathological growth pattern. Higher stage, greater tumor diameter, positive lymphovascular invasion, and a higher score were associated with shorter DFS. In contrast, stage no longer had a significant impact on OS in a multivariable analysis. Acinar/papillary-predominant tumors with a score of 3 or 4 were associated with better survival than those with a score of 5 (5-year DFS rate: 64.68 vs. 44.18%, HR=2.19, 95% CI: 1.24-3.87; 5-year OS rate: 85.61 vs. 68.59%, HR=3.03, 95% CI: 1.25-7.32).
CONCLUSION
The architectural scores may help to stratify survival differences among certain predominant growth subtypes of adenocarcinoma.
目的
我们在一组亚洲早期肺腺癌患者中，研究了基于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）分类的分级系统的预后影响。
材料与方法
纳入2004年至2013年间连续诊断为pT1a - 2aN0M0、直径小于3cm且已接受完整解剖切除的肺腺癌患者。所有标本均根据新的IASLC/ATS/ERS分类进行复查。生长模式分为三大类：贴壁生长为1级，腺泡和乳头模式为2级，实体和微乳头模式为3级。然后根据改良分级系统对每个肿瘤进行分级，最终得分是两个最主要分级的总和。评估临床和病理因素与无病生存期（DFS）和总生存期（OS）的相关性。
结果
总共201例腺癌符合评分分级。只有37例（18.4%）患者具有单纯的病理生长模式。更高的分期、更大的肿瘤直径、阳性淋巴管侵犯和更高的评分与较短的DFS相关。相比之下，在多变量分析中分期对OS不再有显著影响。评分为3或4的以腺泡/乳头为主的肿瘤比评分为5的肿瘤生存更好（5年DFS率：64.68%对44.18%，HR = 2.19，95%CI：1.24 - 3.87；5年OS率：85.61%对68.59%，HR = 3.03，95%CI：1.25 - 7.32）。
结论
结构评分可能有助于区分腺癌某些主要生长亚型之间的生存差异。
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