Xu Kuan, Lv Yilv, Chen Tangbing, Han Yuchen, Huang Hanqing, Yu Hong, Ye Bo
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2024 Aug 31;13(8):1862-1876. doi: 10.21037/tlcr-24-265. Epub 2024 Aug 27.
The International Association for the Study of Lung Cancer (IASLC) pathology panel has proposed a new grading system for invasive lung adenocarcinoma (LADC). This study aims to validate this novel grading system for invasive LADC using propensity score matching (PSM), with a specific focus on patients exhibiting spread through air space (STAS).
We retrospectively analyzed the clinicopathologic features of a large cohort of 910 non-mucinous LADCs with STAS from 2017 to 2020 and classified them according to the novel grading system. We applied PSM to adjust for potential confounders between the grading groups. Kaplan-Meier and Cox proportional hazards models were adopted for prognostic evaluation.
The results showed that the IASLC grading system (grades 2 and 3) stratified well in terms of recurrence-free survival (RFS) and overall survival (OS) (P0.02 and P0.02, respectively) after matching, with Grade 3 being an independent predictor of RFS [hazard ratio (HR), 1.533; P0.02] and OS (HR, 2.765; P0.02) in multivariable models. The concordance index (C-index) and area under the curve (AUC) of the IASLC system were 0.719 and 0.754 for recurrence and 0.844 and 0.891 for death, respectively. In addition, anaplastic lymphoma kinase () fusion and tumor protein p53 () mutations were detected more frequently in grade 3 tumors, while epidermal growth factor receptor () mutations were more prevalent in grade 2 tumors. The IASLC grade did not predict the benefit of adjuvant chemotherapy (ACT).
This study suggests that the new IASLC grading system is a valuable prognostic tool for patients with STAS-positive LADC.
国际肺癌研究协会（IASLC）病理小组提出了一种新的浸润性肺腺癌（LADC）分级系统。本研究旨在使用倾向评分匹配（PSM）验证这种新的浸润性LADC分级系统，特别关注表现为气腔播散（STAS）的患者。
我们回顾性分析了2017年至2020年910例伴有STAS的非黏液性LADC大样本队列的临床病理特征，并根据新的分级系统进行分类。我们应用PSM来调整分级组之间的潜在混杂因素。采用Kaplan-Meier法和Cox比例风险模型进行预后评估。
结果显示，IASLC分级系统（2级和3级）在匹配后的无复发生存期（RFS）和总生存期（OS）方面分层良好（分别为P<0.02和P<0.02），在多变量模型中，3级是RFS的独立预测因素[风险比（HR），1.533；P<0.02]和OS（HR，2.765；P<0.02）。IASLC系统的一致性指数（C指数）和曲线下面积（AUC）在复发方面分别为0.719和0.754，在死亡方面分别为0.844和0.891。此外，间变性淋巴瘤激酶（ALK）融合和肿瘤蛋白p53（TP53）突变在3级肿瘤中更频繁地被检测到，而表皮生长因子受体（EGFR）突变在2级肿瘤中更普遍。IASLC分级不能预测辅助化疗（ACT）的获益。
本研究表明，新的IASLC分级系统是STAS阳性LADC患者的一种有价值的预后工具。
