Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Institution of Thoracic Oncology, Fudan University, Shanghai, 200032, China.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac297.
We comprehensively investigated the morphology patterns of lung cancers associated with cystic airspaces. Our goal was to determine the predictive value of imaging features in a clinical environment.
We collected information about patients with resected lung cancers associated with cystic airspaces from January 2010 to December 2019. Radiological features, clinicopathological characteristics, gene mutations and survival data were analysed comprehensively.
A total of 384 resected lung cancers associated with cystic airspaces were identified and categorized as 4 types: I, thin-wall type (n = 31, 8.1%); II, thick-wall type (n = 113, 29.4%); III, cystic airspace with a nodule type (n = 162, 42.1%) and IV, mixed type (n = 78, 20.3%). There were 27 (7.0%) adenocarcinomas in situ/minimally invasive adenocarcinomas; 237 (61.7%) lung adenocarcinomas; 115 (29.9%) squamous cell carcinomas; and 5 (1.3%) other tumours. The epidermal growth factor receptor mutation rate for type III was the highest (68.4%, P = 0.004). Pre-/minimally invasive adenocarcinomas were commonly featured as thin, pure ground-glass wall-surrounded cystic airspaces with smooth inner surfaces and margins. For patients with lung adenocarcinomas associated with cystic airspaces, type III (odds ratio 2.10; 95% confidence interval 0.55-8.06; P = 0.028) was an independent factor associated with a worse differentiation level. Type I was associated with excellent survival and type II, with the worst prognosis (P < 0.001). Type II (hazard ratio 2.29; 95% confidence interval 1.30-4.04; P = 0.004) was an independent prognostic factor for overall survival.
Morphological patterns could be predictors for gene mutations, invasive status, pathological differentiation and postoperative prognosis for lung adenocarcinomas associated with cystic airspaces.
我们全面研究了与囊性气腔相关的肺癌的形态模式。我们的目标是确定影像学特征在临床环境中的预测价值。
我们收集了 2010 年 1 月至 2019 年 12 月期间接受手术切除的与囊性气腔相关的肺癌患者的信息。对影像学特征、临床病理特征、基因突变和生存数据进行了全面分析。
共确定了 384 例与囊性气腔相关的肺癌，分为 4 种类型：I 型，薄壁型（n=31，8.1%）；II 型，厚壁型（n=113，29.4%）；III 型，囊状气腔伴结节型（n=162，42.1%）和 IV 型，混合型（n=78，20.3%）。其中有 27 例（7.0%）为原位癌/微浸润性腺癌；237 例（61.7%）为肺腺癌；115 例（29.9%）为鳞状细胞癌；5 例（1.3%）为其他肿瘤。III 型表皮生长因子受体突变率最高（68.4%，P=0.004）。前/微浸润性腺癌通常表现为薄壁、纯磨玻璃壁环绕的囊性气腔，具有光滑的内表面和边缘。对于伴有囊性气腔的肺腺癌患者，III 型（比值比 2.10；95%置信区间 0.55-8.06；P=0.028）是与分化程度较差相关的独立因素。I 型与良好的生存相关，II 型与最差的预后相关（P<0.001）。II 型（风险比 2.29；95%置信区间 1.30-4.04；P=0.004）是总生存的独立预后因素。
形态模式可能是预测与囊性气腔相关的肺腺癌基因突变、侵袭状态、病理分化和术后预后的指标。
