Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, G1V 4G5, Canada; Department of Molecular Medicine, Laval University, Quebec City, G1V 0A6, Canada.
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, G1V 4G5, Canada.
Hum Pathol. 2022 Oct;128:56-68. doi: 10.1016/j.humpath.2022.07.007. Epub 2022 Jul 22.
Prognostic stratification of patients surgically resected with invasive pulmonary adenocarcinoma must be improved. Previous studies reported that complex glandular patterns (CGPs), cribriform and fused gland growth patterns, are associated with unfavorable prognosis. The goal of this study is to evaluate the prognostic value of CGPs in patients with resected stage I-IV lung adenocarcinoma. The presence of CGPs as a minor to predominant component was tested for association with overall survival (OS, n = 676) and relapse-free survival (RFS, n = 463) after surgery. CGPs were observed in 284 tumors (42.0%). Cribriform and fused gland were the predominant patterns in 35 and 37 cases, respectively. The presence of cribriform pattern was associated with worse RFS, but not OS. The fused gland pattern alone or grouped into CGPs with the cribriform pattern was not associated with OS and RFS. As a predominant pattern, cribriform was associated with the worse survival compared to the 5 recognized histologic patterns. Patients with fused gland-predominant tumors had 5-year survival that ranged between papillary- and micropapillary-predominant tumors. We conclude that cribriform-predominant, but not fused gland-predominant, is a subtype with poor prognosis similar to the solid and micropapillary subtypes. In contrast, the presence of a minor component of fused gland or CGPs (cribriform + fused gland) is not associated with survival. The cribriform pattern alone offers prognosis stratification improvement, but this effect is attenuated when combined into CGPs to define a subset of acinar-predominant tumors with poor prognosis. This argues against combining cribriform and fused gland into CGPs to summarize high-grade patterns.
浸润性肺腺癌患者的预后分层必须得到改善。既往研究表明，复杂腺体模式（CGPs）、筛状和融合腺体生长模式与不良预后相关。本研究旨在评估 CGPs 在接受手术治疗的 I-IV 期肺腺癌患者中的预后价值。检测 CGPs 作为次要至主要成分的存在与术后总生存（OS，n=676）和无复发生存（RFS，n=463）的相关性。在 284 个肿瘤中观察到 CGPs（42.0%）。35 例和 37 例分别以筛状和融合腺体为主要模式。筛状模式的存在与 RFS 较差相关，但与 OS 无关。单独存在的融合腺体模式或与筛状模式一起分组为 CGPs 与 OS 和 RFS 无关。作为主要模式，与 5 种公认的组织学模式相比，筛状模式与较差的生存相关。融合腺体为主型肿瘤患者的 5 年生存率在乳头和微乳头为主型肿瘤之间。我们得出结论，与实体和微乳头亚型相似，筛状为主型而非融合腺体为主型是预后不良的亚型。相比之下，融合腺体的次要成分或 CGPs（筛状+融合腺体）的存在与生存无关。单独的筛状模式提供了预后分层的改善，但当组合成 CGPs 以定义具有不良预后的腺泡为主型肿瘤的亚组时，这种效果会减弱。这表明不应该将筛状和融合腺体组合成 CGPs 来总结高级别模式。
