Wang Yaqi, Yang Xin, Liu Bing, Yan Shi, Liu Mengfei, Li Xiang, Li Shaolei, Lv Chao, Ma Yuanyuan, Zhou Lixin, Song Zhijie, Xv Wantong, Yang Yue, Lin Dongmei, Wu Nan
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
Ann Surg Oncol. 2022 Feb 24. doi: 10.1245/s10434-022-11444-0.
To evaluate the prognostic value of the percentage of high-grade patterns (micropapillary, solid, and complex glands) in early-stage lung adenocarcinoma (LUAD).
A total of 1049 patients undergoing radical surgery with pathological T1-2N0M0 LUAD were screened retrospectively, and 191 patients were involved in the final analysis. Disease-free survival (DFS) was evaluated using the Kaplan-Meier curve and Cox regression analysis. The optimal cut-off value was determined using maximally selected rank statistics.
The entire cohort was divided into quartile groups based on the percentage of high-grade patterns: Group 1 (≤ 30%), Group 2 (31-55%), Group 3 (56-85%), and Group 4 (≥ 86%). There were significant differences in smoking history (P = 0.041), EGFR mutations (P < 0.001), and ALK rearrangement (P = 0.010) between the four groups, but no significant differences in other clinicopathological features. Kaplan-Meier analysis showed that a higher percentage of high-grade patterns predicted worse DFS (P = 0.001), and multivariate analysis indicated that the percentage of high-grade patterns was an independent predictor (Group 2 vs. Group 1, HR = 2.136, P = 0.228; Group 3 vs. Group 1, HR = 3.355, P = 0.035; Group 4 vs. Group 1, HR = 5.147, P = 0.003, respectively). A cut-off value of 20% (P = 0.048) and 50% (P <0.001) for high-grade patterns were tested, and both revealed a significant difference in distinguishing DFS between subgroups.
The percentage of high-grade patterns is associated with the prognosis of early-stage invasive LUAD. A higher percentage indicates a worse prognosis.
评估高级别模式（微乳头、实性和复杂腺体）百分比在早期肺腺癌（LUAD）中的预后价值。
回顾性筛选1049例行根治性手术的病理T1-2N0M0期LUAD患者，191例患者纳入最终分析。采用Kaplan-Meier曲线和Cox回归分析评估无病生存期（DFS）。使用最大选择秩统计量确定最佳截断值。
根据高级别模式百分比将整个队列分为四分位组：第1组（≤30%）、第2组（31-55%）、第3组（56-85%）和第4组（≥86%）。四组之间吸烟史（P = 0.041）、表皮生长因子受体（EGFR）突变（P < 0.001）及间变性淋巴瘤激酶（ALK）重排（P = 0.010）存在显著差异，但在其他临床病理特征方面无显著差异。Kaplan-Meier分析显示，高级别模式百分比越高，DFS越差（P = 0.001），多因素分析表明高级别模式百分比是独立预测因素（第2组与第1组相比，风险比[HR] = 2.136，P = 0.228；第3组与第1组相比，HR = 3.355，P = 0.035；第4组与第1组相比，HR = 5.147，P = 0.003）。对高级别模式百分比的截断值20%（P = 0.048）和50%（P <0.001）进行检验，二者均显示在区分亚组DFS方面存在显著差异。
高级别模式百分比与早期浸润性LUAD的预后相关。百分比越高，预后越差。
