Csongrád-Csanád County Hospital of Chest Diseases, Deszk, Hungary.
Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary.
Virchows Arch. 2023 Sep;483(3):393-404. doi: 10.1007/s00428-023-03612-8. Epub 2023 Aug 9.
The prognostic markers of lung squamous cell carcinoma (LSCC) are less investigated. The aim of our study was to evaluate tumour budding (TB), minimal cell nest size, nuclear diameter (ND), and spread through air spaces (STAS) among patients with resected LSCC, semi-quantitatively. Furthermore, we aimed to identify a grading system for the best prognostic stratification of LSCC. Patients who underwent surgical resection at the Department of Surgery, University of Szeged between 2010 and 2016 were included. Follow-up data were collected from medical charts. Morphological characteristics were recorded from histologic revision of slides. Kaplan-Meier analysis, log rank test and Cox proportional-hazards model, ROC curve analysis, and intraclass correlation were utilised. Altogether 220 patients were included. In univariate analysis, higher degree of TB, infiltrative tumour border, larger ND, the presence of single cell invasion (SCI) and STAS were associated with adverse prognosis. Based on our results, we proposed an easily applicable grading scheme focusing on TB, ND, and SCI. In multivariate analysis, the proposed grading system (p< 0.001, p< 0.001) and STAS (p= 0.008, p< 0.001) were independent prognosticators. Compared to the previously introduced grading systems, ROC curve analysis revealed that the proposed grade had the highest AUC values (AUC: 0.83, AUC: 0.78). Each category of the proposed grading system has good (ICC: 0.79-0.88) reproducibility. We validated the prognostic impact of TB, SCI, ND, and STAS in LSCC. We recommend a reproducible grading system combining TB, SCI, and ND for proper prognostic stratification of LSCC patients. Further research is required for validation of this grading scheme.
肺鳞状细胞癌 (LSCC) 的预后标志物研究较少。我们的研究目的是评估肿瘤芽（TB）、最小细胞巢大小、核直径（ND）和空气空间扩散（STAS）在接受 LSCC 切除手术的患者中的半定量表现。此外，我们旨在为 LSCC 最佳预后分层确定分级系统。纳入了 2010 年至 2016 年在塞格德大学外科系接受手术的患者。通过病历收集随访数据。从切片的组织学复查中记录形态学特征。利用 Kaplan-Meier 分析、对数秩检验和 Cox 比例风险模型、ROC 曲线分析和组内相关系数进行分析。共纳入 220 例患者。单因素分析显示，TB 程度较高、浸润性肿瘤边界、较大的 ND、存在单个细胞浸润（SCI）和 STAS 与不良预后相关。根据我们的结果，我们提出了一种简单实用的分级方案，重点关注 TB、ND 和 SCI。多因素分析显示，提出的分级系统（p<0.001，p<0.001）和 STAS（p=0.008，p<0.001）是独立的预后预测因素。与之前介绍的分级系统相比，ROC 曲线分析显示提出的分级具有最高的 AUC 值（AUC：0.83，AUC：0.78）。提出的分级系统的每个类别都具有良好的可重复性（ICC：0.79-0.88）。我们验证了 TB、SCI、ND 和 STAS 在 LSCC 中的预后影响。我们建议使用一种可重复的分级系统，将 TB、SCI 和 ND 结合起来，对 LSCC 患者进行适当的预后分层。需要进一步的研究来验证这种分级方案。
