Marghescu Angela-Ștefania, Vlăsceanu Silviu, Preda Mădălina, Mahler Beatrice, Bădărău Ioana Anca, Manolescu Loredana Sabina Cornelia, Țigău Mirela, Teleagă Cristina, Toader Corina Elena, Radu Alexandru Daniel, Stoichiță Alexandru, Costache Mariana
Pathological Anatomy Discipline, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Research, Marius Nasta Institute of Pneumophthisiology, 050159 Bucharest, Romania.
Diagnostics (Basel). 2024 Oct 11;14(20):2264. doi: 10.3390/diagnostics14202264.
Squamous cell carcinoma (SQCC) represents a significant proportion of human malignancies affecting various anatomical sites, including the lung. Understanding the prognostic factors is crucial for establishing effective risk stratification in these patients, as multiple critical aspects significantly impact overall survival.
A retrospective study was conducted on 99 patients with operable lung SQCC treated at a tertiary center. The exclusion criteria included patients under 18, those with in situ or metastatic SQCC, and those who received neoadjuvant therapy. The surgical specimens were re-analyzed, and data were collected on multiple variables, including pTNM staging, tumor characteristics, and overall survival (OS). The Kaplan-Meier survival analysis and Cox regression models were used to identify significant prognostic factors.
The Kaplan-Meier analysis showed a median survival of 36 months with a 65.65% mortality rate. Significant factors influencing survival included keratinization, histological grading, tumor size and stage, pleural invasion, tumor cell arrangement, tumor budding, spread through air space (STAS), and mitotic index. A multiple Cox regression highlighted the nonkeratinizing tumors, advanced pT stages, single-cell invasion, and high mitotic index as key predictors of poorer outcomes. The nonkeratinizing tumors showed higher mortality and shorter median survival rates compared to keratinizing tumors. The tumor staging, cell arrangement, and tumor budding significantly impacted the survival curves.
The study underscores the importance of detailed histopathological evaluations in lung SQCC. The nonkeratinizing tumors, advanced pT stage, single-cell invasion, and high mitotic index were associated with higher hazard rates, emphasizing the need for a comprehensive grading system incorporating these factors to improve prognostic accuracy and guide treatment strategies.
鳞状细胞癌（SQCC）在影响包括肺部在内的各个解剖部位的人类恶性肿瘤中占相当大的比例。了解预后因素对于在这些患者中建立有效的风险分层至关重要，因为多个关键方面会显著影响总生存期。
对在一家三级中心接受治疗的99例可手术切除的肺鳞状细胞癌患者进行了一项回顾性研究。排除标准包括18岁以下患者、原位或转移性鳞状细胞癌患者以及接受新辅助治疗的患者。对手术标本进行重新分析，并收集包括pTNM分期、肿瘤特征和总生存期（OS）等多个变量的数据。采用Kaplan-Meier生存分析和Cox回归模型来确定显著的预后因素。
Kaplan-Meier分析显示中位生存期为36个月，死亡率为65.65%。影响生存的显著因素包括角化程度、组织学分级、肿瘤大小和分期、胸膜侵犯、肿瘤细胞排列、肿瘤芽生、气腔播散（STAS）和有丝分裂指数。多因素Cox回归突出显示非角化性肿瘤、晚期pT分期、单细胞浸润和高有丝分裂指数是预后较差的关键预测因素。与角化性肿瘤相比,非角化性肿瘤显示出更高的死亡率和更短的中位生存期。肿瘤分期、细胞排列和肿瘤芽生对生存曲线有显著影响。
该研究强调了在肺鳞状细胞癌中进行详细组织病理学评估的重要性。非角化性肿瘤、晚期pT分期、单细胞浸润和高有丝分裂指数与较高的风险率相关，强调需要一个纳入这些因素的综合分级系统，以提高预后准确性并指导治疗策略。
