Department of Pathology, Ege University School of Medicine, Bornova, İzmir, Turkey.
Department of Thoracic Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
Histol Histopathol. 2024 Jun;39(6):703-714. doi: 10.14670/HH-18-661. Epub 2023 Sep 5.
In 2020, the International Lung Cancer Study Group (IASLC) Pathology Committee established a grading system for non-mucinous primary lung adenocarcinomas. This grading system is based on whether areas of high-grade patterns are present in more than 20% of the tumor. Parameters, such as necrosis, mitotic activity, lymphovascular invasion (LVI) and spread through air spaces (STAS), are excluded from evaluating the grading system.
A total of 217 patients' lung resection materials for primary lung adenocarcinoma were re-reviewed using the IASLC grading system. Necrosis, mitotic activity, LVI status and STAS were also evaluated in the resection materials, aiming to demonstrate the relationship between these histopathological features and clinical outcome data.
At all stages, overall survival (OS) and recurrence-free survival (RFS) were related to grade (=0.011 and 0.024, respectively). Additionally, patients with necrosis were associated with worse OS and RFS (=0.002 and 0.048, respectively). When grade 2 and 3 tumors were analyzed individually, a significant relationship was found between necrosis and OS in grade 3 tumors (=0.002). Patients with a high mitotic count (≥10/10 high-power fields) had significantly worse OS (=0.046). The prevalence of LVI and STAS increased with grade; however, their prognostic significance has not been demonstrated.
The new grading system provides a highly efficient prognostic classification for survival. Necrosis and high mitotic count are important prognostic parameters for survival. Additionally, necrosis is a stage-independent prognostic factor for OS in grade 3 tumors, although no effect on prognosis can be demonstrated in grade 2 tumors.
2020 年，国际肺癌研究协会（IASLC）病理学委员会为非黏液性原发性肺腺癌建立了一个分级系统。该分级系统基于高级别模式区域是否存在于超过 20%的肿瘤中。在评估分级系统时，排除了坏死、有丝分裂活性、脉管侵犯（LVI）和通过空气空间扩散（STAS）等参数。
共重新审查了 217 例原发性肺腺癌肺切除标本，使用 IASLC 分级系统。还评估了切除标本中的坏死、有丝分裂活性、LVI 状态和 STAS，旨在展示这些组织病理学特征与临床结果数据之间的关系。
在所有分期中，总生存期（OS）和无复发生存期（RFS）与分级相关（分别为=0.011 和 0.024）。此外，有坏死的患者 OS 和 RFS 较差（分别为=0.002 和 0.048）。当单独分析 2 级和 3 级肿瘤时，在 3 级肿瘤中，坏死与 OS 之间存在显著关系（=0.002）。有高有丝分裂计数（≥10/10 高倍视野）的患者 OS 显著较差（=0.046）。LVI 和 STAS 的患病率随分级而增加；然而，其预后意义尚未得到证实。
新的分级系统为生存提供了一种高效的预后分类。坏死和高有丝分裂计数是生存的重要预后参数。此外，坏死是 3 级肿瘤中 OS 的独立于分期的预后因素，尽管在 2 级肿瘤中不能证明对预后有影响。
