Ni Jianjiao, Zheng Zhiqin, Li Juan, Li Yuan, Fan Min, Liu Liang
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Thorac Dis. 2020 Oct;12(10):5593-5602. doi: 10.21037/jtd-20-1979.
Adenosquamous carcinoma (ASC) is a rare and aggressive histologic subtype of non-small cell lung cancer (NSCLC). Little is known about the prognostic significance of routine immunohistochemical (IHC) markers and clinical value of adjuvant radiotherapy in completely resected lung ASC.
Consecutive patients with pathologically confirmed lung ASC receiving curative resection from January 2007 to December 2017 at our center were retrospectively reviewed. The prognostic significance of 14 routine IHC markers and potential candidate of adjuvant radiotherapy were investigated.
With a median follow up of 35 (range, 3.0-138) months, 95 out of the 176 enrolled patients had disease recurrence. The 1-, 3- and 5-year cumulative rate of recurrence was 25.8%, 55.8% and 63.1%, respectively. Using the Cox proportional hazard regression model, T stage, N stage, lymphovascular invasion (LVI), expression of CEA, expression of p53, but not EGFR mutations or expression of the other 12 IHC markers (CK20, CK5/6, PE10, ERCC1, Napsin A, RRM1, Ki67, CK7, P63, EGFR, HER2, TTF1), were significantly associated with postoperative recurrence. N stage, expression of CEA and LVI were identified as independent prognosticators of overall recurrence. Using competing risk methodology and distant recurrence chosen as a competing risk, T stage and N stage were identified as significant risk factors of loco-regional recurrence. Moreover, adjuvant radiotherapy significantly improved disease-free survival (DFS) (P=0.002) and was associated with non-significant longer overall survival (OS) (P=0.078) among 95 patients with either pathological T3-4 or N disease (collectively defined as pT/N disease).
This study provides the proof of concept for using routine IHC markers, along with common clinic-pathological parameters, in predicting postoperative recurrence and identifying potential candidate for adjuvant radiotherapy in completely resected lung ASC.
腺鳞癌（ASC）是一种罕见且侵袭性强的非小细胞肺癌（NSCLC）组织学亚型。对于完全切除的肺ASC，常规免疫组化（IHC）标志物的预后意义及辅助放疗的临床价值知之甚少。
回顾性分析2007年1月至2017年12月在本中心接受根治性切除的经病理证实的肺ASC连续患者。研究14种常规IHC标志物的预后意义及辅助放疗的潜在候选因素。
中位随访35（范围3.0 - 138）个月，176例入组患者中有95例疾病复发。1年、3年和5年的累积复发率分别为25.8%、55.8%和63.1%。使用Cox比例风险回归模型，T分期、N分期、脉管侵犯（LVI）、CEA表达、p53表达，但不包括EGFR突变或其他12种IHC标志物（CK20、CK5/6、PE10、ERCC1、Napsin A、RRM1、Ki67、CK7、P63、EGFR、HER2、TTF1）的表达，与术后复发显著相关。N分期、CEA表达和LVI被确定为总体复发的独立预后因素。使用竞争风险方法并将远处复发作为竞争风险，T分期和N分期被确定为局部区域复发的显著危险因素。此外，在95例病理T3 - 4期或N期（统称为pT/N期）患者中，辅助放疗显著改善了无病生存期（DFS）（P = 0.002），且与总生存期（OS）延长无显著相关性（P = 0.078）。
本研究为在完全切除的肺ASC中使用常规IHC标志物以及常见临床病理参数预测术后复发和识别辅助放疗的潜在候选者提供了概念验证。
