Qiu Zhen-Bin, Wang Meng-Min, Yan Jin-Hai, Zhang Chao, Wu Yi-Long, Zhang Sheng, Zhong Wen-Zhao
Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Shantou University Medical College, Shantou, China.
Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Semin Thorac Cardiovasc Surg. 2023;35(3):594-602. doi: 10.1053/j.semtcvs.2022.06.003. Epub 2022 Jun 13.
To validate the efficiency of pathologic grading system in pathologic stage IA lung adenocarcinoma (LUAD), and explore whether integrating preoperative radiological features would enhance the performance of recurrence discrimination. We retrospectively collected 510 patients with resected stage IA LUAD between January 2012 and December 2019 from Guangdong Provincial People's Hospital (GDPH). Pathologic grade classification of each case was based on the International Association for the Study of Lung Cancer (IASLC) pathologic staging system. Kaplan-Meier curves was used to assess the power of recurrence stratification. Concordance index (C-Index) and receiver operating characteristic curves (ROC) were used for evaluating the clinical utility of different grading systems for recurrence discrimination. Patients of lower IASLC grade showed improved recurrence-free survival (RFS) (P < 0.0001) where numerically difference was found between grade II and grade III (P = 0.119). By integrating the IASLC grading system and radiological feature, we found the RFS rate decreased as the novel radiopathological (RP) grading system increased (P < 0.0001). The difference of RFS curves between any 2 groups as per the RP grading system was statisticallysignificant (RP grade I vs RP grade II, p = 0.007; RP grade I vs RP grade III, P < 0.0001; RP grade II vs RP grade III, P = 0.0003). Compared with the IASLC grading system, the RP grading system remarkably improved recurrence survival discrimination (C-index: 0.822; area under the curve, 0.845). Integrating imaging features into pathologic grading system enhanced the efficiency of recurrence discrimination for resected stage IA LUAD and might help conduct subsequent management.
为验证病理分级系统在病理IA期肺腺癌（LUAD）中的有效性，并探讨整合术前放射学特征是否会提高复发鉴别性能。我们回顾性收集了2012年1月至2019年12月期间来自广东省人民医院（GDPH）的510例接受手术切除的IA期LUAD患者。每个病例的病理分级分类基于国际肺癌研究协会（IASLC）病理分期系统。采用Kaplan-Meier曲线评估复发分层的能力。一致性指数（C-Index）和受试者工作特征曲线（ROC）用于评估不同分级系统对复发鉴别的临床效用。IASLC分级较低的患者无复发生存期（RFS）改善（P < 0.0001），其中II级和III级之间存在数值差异（P = 0.119）。通过整合IASLC分级系统和放射学特征，我们发现随着新的放射病理学（RP）分级系统增加，RFS率降低（P < 0.0001）。根据RP分级系统，任意两组之间的RFS曲线差异具有统计学意义（RP I级与RP II级，p = 0.007；RP I级与RP III级，P < 0.0001；RP II级与RP III级，P = 0.0003）。与IASLC分级系统相比，RP分级系统显著改善了复发生存鉴别（C指数：0.822；曲线下面积，0.845）。将影像特征整合到病理分级系统中可提高手术切除的IA期LUAD复发鉴别的效率，并可能有助于进行后续管理。
