第二主要亚型可预测中恶性浸润性肺腺癌的预后†

Second predominant subtype predicts outcomes of intermediate-malignant invasive lung adenocarcinoma†.

作者信息

Ito Masaoki, Miyata Yoshihiro, Yoshiya Tomoharu, Tsutani Yasuhiro, Mimura Takeshi, Murakami Shuji, Ito Hiroyuki, Nakayama Haruhiko, Okada Morihito

机构信息

Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.

Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan.

出版信息

Eur J Cardiothorac Surg. 2017 Feb 1;51(2):218-222. doi: 10.1093/ejcts/ezw318.

DOI:10.1093/ejcts/ezw318

PMID:28186287

Abstract

OBJECTIVES

Acinar predominant and papillary predominant invasive adenocarcinomas are likely to be classified as intermediate-malignant types. Although these two types of adenocarcinoma are distinguished morphologically, the differences between their malignant behaviours and prognoses are not clear. The aim of this study is to provide a prognostically relevant stratification of these similar subtypes based on pathological features.

METHODS

We retrospectively reviewed 347 consecutive clinically N0M0 lung adenocarcinomas of ≤3 cm in diameter that were resected between April 2006 and December 2010 at two institutes. Acinar and papillary predominant adenocarcinomas were classified into acinar/papillary-lepidic type and acinar/papillary-non-lepidic type according to whether the second predominant component was a lepidic or invasive component.

RESULTS

Fifty-four acinar and 59 papillary predominant adenocarcinoma cases were classified as acinar/papillary-lepidic type (n = 65) or acinar/papillary-non-lepidic type (n = 48) cases. Acinar/papillary-non-lepidic type cases were accompanied by more vascular invasion (13.8% vs 31.3%, P = 0.0451) and pleural invasion (9.2% vs 25.0%, P = 0.0450) than were acinar/papillary-lepidic type cases. Five-year overall survival (OS) and recurrence-free survival (RFS) also differed significantly between these types (5-year OS: acinar/papillary-lepidic type, 96.3% vs acinar/papillary-non-lepidic type, 61.8%, hazard ratio = 6.315, P = 0.00650; 5-year RFS: acinar/papillary-lepidic type, 91.4% vs acinar/papillary-non-lepidic type, 68.8%, hazard ratio = 2.967, P = 0.0210). Multivariate analysis revealed that a second predominant component was an independent prognostic factor for RFS (acinar/papillary-non-lepidic type: hazard ratio = 3.784, 95% confidence interval 1.091–13.128, P = 0.036).

CONCLUSIONS

The pathological second predominant component allows intermediate-malignant adenocarcinomas to be subclassified with prognostic significance. It can be utilized when assessing postoperative risks for recurrence and when considering therapeutic strategies.

摘要

目的

腺泡为主型和乳头为主型浸润性腺癌可能被归类为中间恶性类型。尽管这两种腺癌在形态上有区别，但其恶性行为和预后的差异尚不清楚。本研究的目的是基于病理特征对这些相似亚型进行具有预后相关性的分层。

方法

我们回顾性分析了2006年4月至2010年12月在两家机构切除的347例连续的临床N0M0直径≤3 cm的肺腺癌。根据第二主要成分是鳞屑状还是浸润性成分，将腺泡为主型和乳头为主型腺癌分为腺泡/乳头-鳞屑型和腺泡/乳头-非鳞屑型。

结果

54例腺泡为主型和59例乳头为主型腺癌病例被分类为腺泡/乳头-鳞屑型（n = 65）或腺泡/乳头-非鳞屑型（n = 48）病例。腺泡/乳头-非鳞屑型病例比腺泡/乳头-鳞屑型病例伴有更多的血管侵犯（13.8%对31.3%，P = 0.0451）和胸膜侵犯（9.2%对25.0%，P = 0.0450）。这些类型之间的5年总生存率（OS）和无复发生存率（RFS）也有显著差异（5年OS：腺泡/乳头-鳞屑型，96.3%对腺泡/乳头-非鳞屑型，61.8%，风险比=6.315，P = 0.00650；5年RFS：腺泡/乳头-鳞屑型，91.4%对腺泡/乳头-非鳞屑型，68.8%，风险比=2.967，P = 0.0210）。多因素分析显示，第二主要成分是RFS的独立预后因素（腺泡/乳头-非鳞屑型：风险比=3.784，95%置信区间1.091–13.128，P = 0.036）。