Department of Pulmonary Medicine, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, 00270, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, 00270, Helsinki, Finland.
Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, 00270, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, 00270, Helsinki, Finland.
Hum Pathol. 2020 Apr;98:110-119. doi: 10.1016/j.humpath.2020.02.007. Epub 2020 Mar 3.
Diffuse malignant mesothelioma (DMM) of the pleura is a rare and aggressive disease, wherein the long-term survival (LTS) rate is low. The epithelioid subtype is the most prevalent form of DMM with the best prognosis. To study prognostic histopathologic factors associated with extended survival in epithelioid DMM, we examined 43 tumors from patients with survival more than five years (LTSs) and compared the findings with 84 tumors from a reference group (RG) with average survival. We analyzed the tumors considering previously published histopathological prognostic features and attempted to identify additional morphological features predictive of extended survival. Most of the LTS tumors presented with nuclear grade I (n = 34, 90%) and a tubulopapillary growth pattern (n = 30, 70%). One LTS tumor had necrosis. In contrast, nuclear grade II (n = 49, 61%) and solid growth pattern (n = 59, 70%) were more frequent in the RG, and necrosis was present in 16 (19%) tumors. We also evaluated the association of asbestos lung tissue fiber burden quantified from autopsy samples with histopathological features and found that elevated asbestos fiber was associated with higher nuclear grade (P < 0.001) and the presence of necrosis (P = 0.021). In univariate survival analysis, we identified the following three novel morphological features associated with survival: exophytic polypoid growth pattern, tumor density, and single mesothelium layered tubular structures. After adjustments, low nuclear grade (P < 0.001) and presence of exophytic polypoid growth (P = 0.024) were associated with prolonged survival. These results may aid in estimating DMM prognosis.
弥漫性恶性间皮瘤（DMM）是一种罕见且侵袭性的疾病，其长期生存（LTS）率较低。上皮样亚型是 DMM 最常见的形式，预后最好。为了研究与上皮样 DMM 延长生存相关的预后组织病理学因素，我们检查了 43 例生存时间超过 5 年（LTS）的患者肿瘤，并将这些发现与 84 例平均生存时间的参考组（RG）肿瘤进行了比较。我们分析了肿瘤，考虑了以前发表的组织病理学预后特征，并试图确定其他形态学特征来预测延长生存。大多数 LTS 肿瘤表现为核级 I（n=34，90%）和管状乳头状生长模式（n=30，70%）。一个 LTS 肿瘤有坏死。相比之下，RG 中核级 II（n=49，61%）和实体生长模式（n=59，70%）更为常见，16 个（19%）肿瘤有坏死。我们还评估了从尸检样本中定量的石棉肺组织纤维负荷与组织病理学特征的关系，发现石棉纤维升高与较高的核级（P<0.001）和坏死的存在（P=0.021）相关。在单因素生存分析中，我们确定了与生存相关的三个新的形态学特征：外生性息肉样生长模式、肿瘤密度和单层间皮管状结构。调整后，低核级（P<0.001）和外生性息肉样生长的存在（P=0.024）与延长生存相关。这些结果可能有助于估计 DMM 的预后。
