Kodama T
Gan To Kagaku Ryoho. 1986 Sep;13(9):2708-17.
It is well known that the biological behavior of lung cancer varies according to histological type and growth pattern. Therefore, more precise analysis of various morphologic features affecting prognosis are needed based on tumor histology. Lung cancer is mainly classified into 4 major histological types; squamous cell carcinoma, small cell carcinoma, adenocarcinoma and large cell carcinoma. Recently lung cancer has been subclassified into small cell carcinoma and non-small cell carcinoma on the basis of responsiveness to chemotherapy and radiation therapy. In small cell carcinoma, combination of chemotherapy and radiation therapy is the main modality for treatment, and the most important prognostic factor is LD and ED stage classification. Even so, a new histological classification is proposed according to the responsiveness to chemotherapy and radiation therapy. On the other hand, surgical therapy is the first choice for the treatment of non-small cell lung cancer and the most important prognostic factor is TNM and related stage classification. In squamous cell carcinoma, moreover, extended resection is sometimes tried because of its local invasiveness. Early lung cancer of hilar type is mostly squamous cell carcinoma and highly curative by resection. The biological behavior of adenocarcinoma is the most variable among lung cancers. In the histopathological study of surgically resected cases, moreover, histological differentiation, nuclear atypia of tumor cells, mitotic frequency, grades of scarring associated with a tumor, and degrees of infiltration of T-zone histiocytes is closely related to prognosis. Scoring of these factors may help a clinician to reach a decision on the necessity and type of postoperative adjuvant chemotherapy, particularly in cases of Stage I adenocarcinoma. Most cases of large cell carcinoma including giant cell carcinoma ultrastructurally reveal features of differentiation toward adenocarcinoma and/or squamous cell carcinoma. Giant cell carcinoma shows the most unfavorable prognosis because of its rapid growth. However, among operable cases of giant cell carcinoma, some long-term survivors do exist. Evaluating these forms of biological behavior according to tumor histology at the time of treatment, it is easier to decide whether or not adjuvant therapy is necessary.
众所周知，肺癌的生物学行为因组织学类型和生长模式而异。因此，需要根据肿瘤组织学对影响预后的各种形态学特征进行更精确的分析。肺癌主要分为4种主要组织学类型：鳞状细胞癌、小细胞癌、腺癌和大细胞癌。最近，根据对化疗和放疗的反应性，肺癌被重新分类为小细胞癌和非小细胞癌。在小细胞癌中，化疗和放疗联合是主要治疗方式，最重要的预后因素是LD和ED分期。即便如此，根据对化疗和放疗的反应性仍提出了一种新的组织学分类。另一方面，手术治疗是非小细胞肺癌的首选治疗方法，最重要的预后因素是TNM及相关分期。此外，由于鳞状细胞癌具有局部侵袭性，有时会尝试扩大切除术。肺门型早期肺癌大多为鳞状细胞癌，手术切除治愈率高。腺癌的生物学行为在肺癌中变化最大。此外，在手术切除病例的组织病理学研究中，组织学分化、肿瘤细胞核异型性、有丝分裂频率、与肿瘤相关的瘢痕分级以及T区组织细胞浸润程度与预后密切相关。对这些因素进行评分可能有助于临床医生决定术后辅助化疗的必要性和类型，特别是对于Ⅰ期腺癌患者。包括巨细胞癌在内的大多数大细胞癌在超微结构上显示出向腺癌和/或鳞状细胞癌分化的特征。巨细胞癌由于生长迅速，预后最差。然而，在可手术的巨细胞癌病例中，确实存在一些长期存活者。在治疗时根据肿瘤组织学评估这些生物学行为形式，更容易决定是否需要辅助治疗。
