Department of Histopathology, London, United Kingdom.
Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
Am J Clin Pathol. 2020 Jun 8;154(1):88-102. doi: 10.1093/ajcp/aqaa026.
The prognostic significance of pathologic features and invasive size has not been well studied for invasive mucinous adenocarcinoma (IMA). This study evaluates the significance of pathologic features and invasive size in relation to clinical outcome.
We reviewed the pathologic features in 84 IMAs, including histologic pattern, nuclear atypia, mitosis, necrosis, and lymphovascular invasion. The invasive size was calculated from the total size using the percentage of invasive components. Cases were subdivided into two pathologic grades based on five pathologic features, and the pathologic grade and adjusted T (aT) stage were correlated with disease-free and overall survival (OS).
Necrosis and N stage were significantly associated with aT stage, and a significant association was noted between OS and aT stage. Nuclear atypia, mitosis, and lymphovascular and pleural invasion also showed a significant association with OS. High-grade tumors showing a significantly worse OS compared with low-grade tumors, as well as pathologic grade (hazard ratio [HR], 2.337; P = .043) and aT stage (HR, 1.875; P = .003), were independent prognostic factors in multivariate analysis.
The pathologic grading system stratified IMAs into high- and low-grade tumors with significant differences in OS. Invasive size may provide a better prognostic stratification for OS.
浸润性黏液腺癌（IMA）的病理特征和侵袭性大小的预后意义尚未得到充分研究。本研究评估了病理特征和侵袭性大小与临床结果的关系。
我们回顾了 84 例 IMA 的病理特征，包括组织学模式、核异型性、有丝分裂、坏死和脉管侵犯。侵袭性大小通过使用侵袭性成分的百分比从总大小计算得出。根据五个病理特征将病例分为两个病理等级，病理等级和调整 T（aT）分期与无病生存和总生存（OS）相关。
坏死和 N 分期与 aT 分期显著相关，OS 与 aT 分期也显著相关。核异型性、有丝分裂、脉管和胸膜侵犯与 OS 也有显著相关性。与低级别肿瘤相比，高级别肿瘤的 OS 显著更差，病理分级（风险比 [HR]，2.337；P=0.043）和 aT 分期（HR，1.875；P=0.003）是多因素分析中的独立预后因素。
病理分级系统将 IMA 分为高、低级别肿瘤，OS 差异显著。侵袭性大小可能为 OS 提供更好的预后分层。
