University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Lung Cancer. 2020 May;143:12-18. doi: 10.1016/j.lungcan.2020.03.004. Epub 2020 Mar 7.
Staging of non-small cell lung carcinoma associated with scar is not discussed in detail in the current American Joint Committee on Cancer staging manual. The recommendation is to include the scar area in the tumor size measurement unless the tumor represents a small focus at the edge of the scar. The aim of this study is to investigate if subtraction of the size of the central scar from the total gross size of surgically resected peripheral clinical stage I non-small cell lung carcinoma improves patient stratification into more accurate prognostic groups.
Hematoxylin and eosin sections of 148 non-small cell lung carcinomas (98 adenocarcinomas and 50 squamous cell carcinomas) were reviewed, including 44 adenocarcinomas and 9 squamous cell carcinomas with scar and 54 adenocarcinomas and 41 squamous cell carcinomas without scar. The microscopic size of the invasive tumor component was determined after the average percentage of scar tissue was subtracted from the grossly measured tumor diameter. Manual results were compared to digital image analysis.
Adenocarcinoma with scar were associated with better overall (80.5 % vs. 63.2 %, p = 0.026) and cancer specific survival (95.2 % vs. 73.3 %, p = 0.0053) when compared to adenocarcinoma without scar. Better cancer specific survival was observed in acinar and papillary predominant adenocarcinoma (95.8 % with scar vs. 67.8 % without scar, p = 0.01); while similar trend although not statistically significant was observed in adenocarcinomas with solid or micropapillary component. Using microscopic size, pathologic T stage was down-staged in 21 adenocarcinomas. Squamous cell carcinoma with or without scar did not show a difference in survival. Manual and quantitative image analysis showed strong correlation (r = 0.9769, p < 0.0001).
Our study suggests that microscopic size of the invasive component in acinar and papillary predominant adenocarcinoma with scar might be a better predictor of survival than the total gross size.
当前的美国癌症联合委员会（AJCC）分期手册并未详细讨论与瘢痕相关的非小细胞肺癌的分期。建议将瘢痕区域纳入肿瘤大小测量中，除非肿瘤代表瘢痕边缘的一个小焦点。本研究旨在探讨从手术切除的外周临床 I 期非小细胞肺癌的总大体大小中减去中央瘢痕的大小是否可以改善患者分层，更准确地预测预后。
回顾了 148 例非小细胞肺癌（98 例腺癌和 50 例鳞癌）的苏木精和伊红切片，其中包括 44 例腺癌和 9 例鳞癌伴瘢痕，54 例腺癌和 41 例鳞癌无瘢痕。在从大体测量的肿瘤直径中减去瘢痕组织的平均百分比后，确定侵袭性肿瘤成分的显微镜下大小。手动结果与数字图像分析进行了比较。
与无瘢痕的腺癌相比，伴瘢痕的腺癌具有更好的总体生存率（80.5%对 63.2%，p=0.026）和癌症特异性生存率（95.2%对 73.3%，p=0.0053）。在以腺泡和乳头状为主的腺癌中观察到更好的癌症特异性生存率（有瘢痕的 95.8%对无瘢痕的 67.8%，p=0.01）；而在具有实性或微乳头状成分的腺癌中，虽然没有统计学意义，但也观察到了类似的趋势。使用显微镜下大小，21 例腺癌的病理 T 分期降期。伴或不伴瘢痕的鳞癌在生存率方面没有差异。手动和定量图像分析显示出很强的相关性（r=0.9769，p<0.0001）。
我们的研究表明，伴有瘢痕的以腺泡和乳头状为主的腺癌中侵袭性成分的显微镜下大小可能比总大体大小更能预测生存率。
