Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
Lung Cancer. 2019 Aug;134:238-244. doi: 10.1016/j.lungcan.2019.06.027. Epub 2019 Jun 27.
To further investigate the relationship between the cribriform component and spread through air spaces (STAS), and to unravel the potential pathological mechanism of poor prognoses in lung adenocarcinoma (LUAD) patients with a cribriform component.
We retrospectively reviewed the clinicopathological characteristics of 208 LUADs. The cribriform component was identified by hematoxylin and eosin staining. The identification of STAS referred to our previous study. The relationship between the cribriform component and STAS was determined by using a logistic regression model. The effects of the cribriform component and STAS on prognosis were analyzed using a Cox proportional hazards regression model.
LUAD patients with a cribriform component had significantly inferior outcomes and increased risk of both locoregional and distant recurrences when compared with those with no cribriform component (p < 0.001). Among 67 patients with a cribriform component presented, 48 (71.6%) cases had STAS. The logistic regression model identified that the cribriform component was an independent risk factor for the presence of STAS (p = 0.044). Subgroup analysis showed that Crib+ (cribriform component present)/STAS+ (spread through air spaces positive) patients had significantly inferior outcomes when compared with Crib+/STAS- (spread through air spaces negative) patients (p < 0.001). Moreover, the multivariate Cox regression analysis further confirmed that STAS was an independent risk factor for a worsening recurrence-free survival (RFS) (p = 0.001) and overall survival (OS) (p < 0.001) in LUAD patients with a cribriform component.
Our results indicated that STAS was more frequently observed in LUAD patients with a cribriform component. Moreover, STAS could provide helpful prognostic information in patients with stage I-III LUAD with a cribriform component.
进一步探讨筛状结构成分与气腔内播散（STAS）之间的关系，并阐明具有筛状结构成分的肺腺癌（LUAD）患者预后不良的潜在病理机制。
我们回顾性分析了 208 例 LUAD 的临床病理特征。采用苏木精和伊红染色法鉴定筛状结构成分。STAS 的鉴定参考了我们之前的研究。采用逻辑回归模型确定筛状结构成分与 STAS 之间的关系。采用Cox 比例风险回归模型分析筛状结构成分和 STAS 对预后的影响。
与无筛状结构成分的 LUAD 患者相比，具有筛状结构成分的 LUAD 患者的预后明显较差，局部和远处复发的风险增加（p<0.001）。在 67 例具有筛状结构成分的患者中，有 48 例（71.6%）存在 STAS。逻辑回归模型确定筛状结构成分是 STAS 存在的独立危险因素（p=0.044）。亚组分析显示，Crib+（筛状结构成分存在）/STAS+（气腔内播散阳性）患者的预后明显差于 Crib+/STAS-（气腔内播散阴性）患者（p<0.001）。此外，多变量 Cox 回归分析进一步证实，STAS 是具有筛状结构成分的 LUAD 患者无复发生存（RFS）（p=0.001）和总生存（OS）（p<0.001）恶化的独立危险因素。
我们的研究结果表明，LUAD 患者中筛状结构成分更常伴有 STAS。此外，STAS 可为具有筛状结构成分的 I-III 期 LUAD 患者提供有价值的预后信息。
