Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
J Thorac Oncol. 2020 Jan;15(1):29-49. doi: 10.1016/j.jtho.2019.08.2506. Epub 2019 Sep 20.
Molecular and immunologic breakthroughs are transforming the management of thoracic cancer, although advances have not been as marked for malignant pleural mesothelioma where pathologic diagnosis has been essentially limited to three histologic subtypes.
A multidisciplinary group (pathologists, molecular biologists, surgeons, radiologists, and oncologists), sponsored by European Network for Rare Adult Solid Cancers/International Association for the Study of Lung Cancer, met in 2018 to critically review the current classification.
Recommendations include: (1) classification should be updated to include architectural patterns and stromal and cytologic features that refine prognostication; (2) subject to data accrual, malignant mesothelioma in situ could be an additional category; (3) grading of epithelioid malignant pleural mesotheliomas should be routinely undertaken; (4) favorable/unfavorable histologic characteristics should be routinely reported; (5) clinically relevant molecular data (programmed death ligand 1, BRCA 1 associated protein 1 [BAP1], and cyclin dependent kinase inhibitor 2A) should be incorporated into reports, if undertaken; (6) other molecular data should be accrued as part of future trials; (7) resection specimens (i.e., extended pleurectomy/decortication and extrapleural pneumonectomy) should be pathologically staged with smaller specimens being clinically staged; (8) ideally, at least three separate areas should be sampled from the pleural cavity, including areas of interest identified on pre-surgical imaging; (9) image-acquisition protocols/imaging terminology should be standardized to aid research/refine clinical staging; (10) multidisciplinary tumor boards should include pathologists to ensure appropriate treatment options are considered; (11) all histologic subtypes should be considered potential candidates for chemotherapy; (12) patients with sarcomatoid or biphasic mesothelioma should not be excluded from first-line clinical trials unless there is a compelling reason; (13) tumor subtyping should be further assessed in relation to duration of response to immunotherapy; and (14) systematic screening of all patients for germline mutations is not recommended, in the absence of a family history suspicious for BAP1 syndrome.
These multidisciplinary recommendations for pathology classification and application will allow more informative pathologic reporting and potential risk stratification, to support clinical practice, research investigation and clinical trials.
分子和免疫学的突破正在改变胸部癌症的治疗方法，尽管在恶性胸膜间皮瘤方面的进展并不明显，其病理诊断基本上仅限于三种组织学亚型。
由欧洲罕见成人实体瘤网络/国际肺癌研究协会赞助的多学科小组（病理学家、分子生物学家、外科医生、放射科医生和肿瘤学家）于 2018 年开会，对当前的分类进行了严格审查。
建议包括：(1)分类应更新，纳入改善预后的结构模式和间质及细胞学特征；(2)在数据积累的前提下，间皮瘤原位可作为另一个类别；(3)上皮样恶性胸膜间皮瘤的分级应常规进行；(4)应常规报告有利/不利的组织学特征；(5)如果进行，应将临床相关的分子数据（程序性死亡配体 1、BRCA1 相关蛋白 1[BAP1]和细胞周期蛋白依赖性激酶抑制剂 2A）纳入报告；(6)应积累其他分子数据作为未来试验的一部分；(7)切除标本（即广泛胸膜切除术/剥脱术和胸膜外全肺切除术）应进行病理分期，较小标本进行临床分期；(8)理想情况下，应从胸膜腔中至少采集三个单独的区域，包括术前影像学上确定的感兴趣区域；(9)应标准化图像采集协议/成像术语，以帮助研究/细化临床分期；(10)多学科肿瘤委员会应包括病理学家，以确保考虑适当的治疗选择；(11)所有组织学亚型都应被视为化疗的潜在候选者；(12)除非有充分的理由，否则不应将肉瘤样或双相间皮瘤患者排除在一线临床试验之外；(13)应进一步评估肿瘤亚型与免疫治疗反应持续时间的关系；(14)在没有家族史可疑 BAP1 综合征的情况下，不建议对所有患者进行种系突变的系统筛查。
这些病理学分类和应用的多学科建议将允许更具信息量的病理学报告和潜在的风险分层，以支持临床实践、研究调查和临床试验。
