基于治疗前活检的微乳头和/或实体组织学亚型可预测肺腺癌热消融术后的局部复发。
Micropapillary and/or Solid Histologic Subtype Based on Pre-Treatment Biopsy Predicts Local Recurrence After Thermal Ablation of Lung Adenocarcinoma.
作者信息
Gao Song, Stein Seth, Petre Elena N, Shady Waleed, Durack Jeremy C, Ridge Carole, Adusumilli Prasad, Rekhtman Natasha, Solomon Stephen B, Ziv Etay
机构信息
Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, Howard-118, 1275 York Ave, New York, NY, 10065, USA.
Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, China.
出版信息
Cardiovasc Intervent Radiol. 2018 Feb;41(2):253-259. doi: 10.1007/s00270-017-1760-8. Epub 2017 Aug 2.
BACKGROUND
To investigate whether histologic subtyping from biopsies can predict local recurrence after thermal ablation for lung adenocarcinoma.
METHODS
Patients treated with CT-guided thermal ablation for lung adenocarcinoma that had pre-ablation needle biopsy with analysis of histologic components were identified. Age, gender, smoking status, treatment indication (primary stage 1 tumor versus salvage), histologic subtype, ground-glass radiographic appearance, tumor size, ablation modality, and ablation margin were evaluated in relation to time to local recurrence (TTLR). Cumulative incidence of recurrence (CIR) was calculated using competing risks analysis and compared across groups using Fine and Grey method with clustering. Multivariate analysis was conducted with stepwise regression.
RESULTS
There were 53 patients with 57 tumors diagnosed as adenocarcinoma on pre-ablation biopsy and with histologic subtype analysis. Of these, 19% (11) had micropapillary components, 14% (8) had solid components, and 26% (15) had micropapillary and/or solid components. In the univariate analysis, solid (subdistribution hazard ratio [SHR] = 4.04, p = 0.0051, 95% confidence interval [CI] = 1.52-10.7), micropapillary (SHR = 3.36, p = 0.01, CI = 1.33-8.47), and micropapillary and/or solid components (SHR = 5.85, p = 0.00038, CI = 2.21-15.5) were significantly correlated with shorter TTLR. On multivariate analysis, the presence of micropapillary and/or solid component (SHR = 11.4, p = 0.00021, CI: 3.14-41.3) was the only independent predictor of TTLR. The 1-, 2-, and 3-year CIR in patients with micropapillary and/or solid components was 33, 49, and 66% compared to 5, 14, and 18% in patients with no micropapillary or solid components on biopsy specimens.
CONCLUSION
Micropapillary and/or solid histologic components identified in pre-ablation biopsy are associated with shorter TTLR after thermal ablation of lung adenocarcinoma.
背景
探讨肺腺癌活检的组织学亚型能否预测热消融术后的局部复发。
方法
纳入接受CT引导下肺腺癌热消融治疗且术前经皮穿刺活检并分析组织学成分的患者。评估年龄、性别、吸烟状况、治疗指征（I期原发肿瘤与挽救性治疗）、组织学亚型、磨玻璃样影像学表现、肿瘤大小、消融方式及消融切缘与局部复发时间（TTLR）的关系。采用竞争风险分析计算复发累积发生率（CIR），并使用Fine和Grey法及聚类分析对各组进行比较。采用逐步回归进行多因素分析。
结果
53例患者共57个肿瘤在术前活检时被诊断为腺癌并进行了组织学亚型分析。其中，19%（11个）有微乳头成分，14%（8个）有实性成分，26%（15个）有微乳头和/或实性成分。单因素分析中，实性成分（亚分布风险比[SHR]=4.04，p=0.0051，95%置信区间[CI]=1.52-10.7）、微乳头成分（SHR=3.36，p=0.01，CI=1.33-8.47）以及微乳头和/或实性成分（SHR=5.85，p=0.00038，CI=2.21-15.5）均与较短的TTLR显著相关。多因素分析中，微乳头和/或实性成分的存在（SHR=11.4，p=0.00021，CI：3.14-41.3）是TTLR的唯一独立预测因素。活检标本中有微乳头和/或实性成分的患者1年、2年和3年CIR分别为33%、49%和66%，而无微乳头或实性成分的患者分别为5%、14%和18%。
结论
术前活检中发现的微乳头和/或实性组织学成分与肺腺癌热消融术后较短的TTLR相关。
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