Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China.
Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China.
Mod Pathol. 2021 May;34(5):883-894. doi: 10.1038/s41379-020-00711-8. Epub 2020 Nov 16.
Our study aimed to validate the clinicopathological characteristics and prognosis of lung adenocarcinoma (ADC) with a filigree pattern and to further investigate the relationship between the filigree pattern and the classical micropapillary (MP) pattern. We retrospectively reviewed the clinical and pathologic characteristics of 461 Chinese patients with completely resected ADC (stage I, 310; stage II, 44; stage III, 107). The filigree pattern was more likely to be observed in ADC with a higher stage (p = 0.003) and the classical MP pattern (p < 0.001). Patients with filigree-predominant ADC showed poor survival, similar to those with classical MP-predominant ADC. Multivariate analysis confirmed that the presence of the filigree pattern was an independent prognostic factor for recurrence-free survival (hazard ratio (HR), 2.01; 95% confidence interval (CI), 1.50-2.68; p < 0.001) and overall survival (OS; HR, 1.83; 95% CI, 1.34-2.50; p < 0.001). Patients with both classical MP-positive and filigree-positive ADC had the worst survival compared with those with the filigree pattern or classical MP pattern alone. In stage I, ADC with both the filigree and classical MP patterns had a higher incidence of micrometastasis than ADC with the filigree pattern or classical MP pattern alone. Lymph node micrometastasis indicated poor survival in patients with ADC with the filigree pattern or classical MP pattern. Similar clinicopathologic features between patients with the filigree pattern and the classical MP pattern support the inclusion of the filigree pattern in the MP category. Recognition of the filigree pattern could provide helpful prognostic information, especially for stage I ADC.
我们的研究旨在验证具有丝状模式的肺腺癌（ADC）的临床病理特征和预后，并进一步研究丝状模式与经典微乳头状（MP）模式之间的关系。我们回顾性分析了 461 例完全切除的中国肺 ADC 患者（I 期 310 例，II 期 44 例，III 期 107 例）的临床和病理特征。丝状模式更可能出现在较高分期的 ADC（p=0.003）和经典的 MP 模式中（p<0.001）。具有丝状为主的 ADC 患者的生存较差，与具有经典 MP 为主的 ADC 患者相似。多变量分析证实，丝状模式的存在是无复发生存（风险比（HR），2.01；95%置信区间（CI），1.50-2.68；p<0.001）和总生存（OS；HR，1.83；95%CI，1.34-2.50；p<0.001）的独立预后因素。同时具有经典 MP 阳性和丝状阳性的 ADC 患者的生存最差，与仅具有丝状模式或经典 MP 模式的患者相比。在 I 期，同时具有丝状和经典 MP 模式的 ADC 比单独具有丝状模式或经典 MP 模式的 ADC 更易发生微转移。丝状或经典 MP 模式的 ADC 中存在淋巴结微转移预示着患者的生存不良。具有丝状模式和经典 MP 模式的患者具有相似的临床病理特征，支持将丝状模式纳入 MP 分类。认识丝状模式可以提供有帮助的预后信息，特别是对于 I 期 ADC。
