Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.
J Cancer Res Clin Oncol. 2019 Oct;145(10):2495-2506. doi: 10.1007/s00432-019-03012-z. Epub 2019 Sep 7.
Histology samples are important for the appropriate administration of tumor type-specific cytotoxic and molecular-targeted therapies for the treatment of non-small cell lung cancer (NSCLC). When biopsy samples lack a definite morphology, a diagnosis can be selected from three subtypes based on immunohistochemistry (IHC) results, as follows: favor adenocarcinoma (ADC), favor squamous cell carcinoma (SQC), or not otherwise specified (NOS)-null. In terms of patient outcome, however, the validity of IHC-based classifications remains unknown.
A large series of 152 patients with advanced NSCLC whose diagnoses had been made based on morphological findings and who had been homogeneously treated were enrolled. We used IHC staining (TTF-1, SP-A, p40, and CK5/6) to examine tumor samples and refined the diagnoses. We then analyzed the pathological subgroups according to the IHC staining results.
IHC profiling resulted in 50% of the cases being classified as favor ADC, 31% being classified as favor SQC, and 19% being classified as NOS-null groups. Compared with the favor ADC and favor SQC groups, the NOS-null group had a significantly poorer outcome. Pemetrexed-containing platinum regimens produced a response rate similar to that of other platinum doublet regimens in the favor ADC group (44% vs. 46%), whereas it produced a poorer response in the favor SQC group (0% vs. 52%) and the NOS-null group (0% vs. 24%). The favor ADC group tended to have a higher percentage of EGFR positivity and ALK positivity than the favor SQC group (25% vs. 11% and 7% vs. 0%, respectively).
These findings support the use of immunohistological subtyping of NSCLC biopsy specimens to select patient-appropriate treatments.
组织学样本对于非小细胞肺癌（NSCLC）的肿瘤类型特异性细胞毒性和分子靶向治疗的合理应用非常重要。当活检样本缺乏明确的形态时，可以根据免疫组织化学（IHC）结果从以下三种亚型中选择诊断结果：倾向于腺癌（ADC）、倾向于鳞状细胞癌（SQC）或未另行指定（NOS）-空。然而，就患者的预后而言，基于 IHC 的分类的有效性尚不清楚。
本研究纳入了 152 例晚期 NSCLC 患者，这些患者的诊断是基于形态学发现，并进行了同质治疗。我们使用 IHC 染色（TTF-1、SP-A、p40 和 CK5/6）检查肿瘤样本，并对诊断进行了细化。然后，我们根据 IHC 染色结果分析了病理亚组。
IHC 分析结果显示，50%的病例被归类为倾向 ADC，31%的病例被归类为倾向 SQC，19%的病例被归类为 NOS-空组。与倾向 ADC 和倾向 SQC 组相比，NOS-空组的预后明显较差。培美曲塞联合铂类方案在倾向 ADC 组中的反应率与其他铂类双联方案相似（44%比 46%），而在倾向 SQC 组（0%比 52%）和 NOS-空组（0%比 24%）中反应率较差。倾向 ADC 组 EGFR 阳性和 ALK 阳性的比例均高于倾向 SQC 组（分别为 25%比 11%和 7%比 0%）。
这些发现支持使用免疫组织化学亚分型来选择适合患者的治疗方案。
