Fujikawa Ryo, Muraoka Yuji, Kashima Jumpei, Yoshida Yukihiro, Ito Kimiteru, Watanabe Hirokazu, Kusumoto Masahiko, Watanabe Shun-Ichi, Yatabe Yasushi
Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.
J Thorac Oncol. 2022 May;17(5):700-707. doi: 10.1016/j.jtho.2022.02.005. Epub 2022 Feb 25.
The new grading system proposed by the Pathology Committee of the International Association for the Study of Lung Cancer in 2020 was based on the combination of the histologically predominant subtype and high-grade component. Because the predominant subtypes are associated with characteristic subsets, unique subsets can be identified by this grading system.
We analyzed the clinicopathologic, genotypic, and prognostic features of a cohort of 781 consecutive patients with invasive nonmucinous adenocarcinoma of the lung.
Grade 3 tumors were associated with younger age, male sex, a higher smoking dose, and aggressive features (tumor size, lymph node metastasis, stage, lymphovascular invasion, and pleural invasion). Recurrence-free survival and 3-year overall survival were well-stratified according to tumor grade, and the differences were confirmed with multivariate analysis using the Cox proportional hazard model. Radiologically, most grade 3 tumors exhibit a solid nodular pattern on computed tomography images and a high maximum standardized uptake value with positron emission tomography. Genotypically, 43% of the grade 3 adenocarcinomas lacked any driver mutations, although one of the driver mutations was detected in 79% of grade 1 or 2 tumors. Patient age, positive smoking history, solid nodule on computed tomography image, and higher maximum standardized uptake value were identified as significant preoperative predictive factors of grade 3 tumors, with a prediction rate greater than 90%.
Besides stratifying the patient outcomes, the new grading system characterized unique clinicopathologic subsets and this study suggested that grade 3 tumors could be predicted using the preoperative variables.
国际肺癌研究协会病理委员会于2020年提出的新分级系统是基于组织学上的主要亚型和高级别成分的组合。由于主要亚型与特定子集相关，通过该分级系统可以识别出独特的子集。
我们分析了781例连续的肺浸润性非黏液腺癌患者的临床病理、基因和预后特征。
3级肿瘤与较年轻的年龄、男性、较高的吸烟量以及侵袭性特征（肿瘤大小、淋巴结转移、分期、淋巴管浸润和胸膜浸润）相关。根据肿瘤分级，无复发生存率和3年总生存率得到了很好的分层，并且使用Cox比例风险模型进行多变量分析证实了这些差异。在放射学上，大多数3级肿瘤在计算机断层扫描图像上表现为实性结节模式，在正电子发射断层扫描上表现为较高的最大标准化摄取值。在基因方面，43%的3级腺癌没有任何驱动突变，而在1级或2级肿瘤中，79%检测到了一种驱动突变。患者年龄、阳性吸烟史、计算机断层扫描图像上的实性结节以及较高的最大标准化摄取值被确定为3级肿瘤的重要术前预测因素，预测率大于90%。
除了对患者预后进行分层外，新分级系统还对独特的临床病理子集进行了特征描述，并且本研究表明可以使用术前变量预测3级肿瘤。
