Guo Wen, Ruan Huanrong, Zhou Miao, Lei Siyuan, Li Jiansheng
Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China; Co-construction Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province/Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou 450046, China.
Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China.
Ann Diagn Pathol. 2025 Aug;77:152466. doi: 10.1016/j.anndiagpath.2025.152466. Epub 2025 Mar 10.
In 2020, the International Association for the Study of Lung Cancer (IASLC) introduced a new grading system for invasive pulmonary adenocarcinoma (IPA). This meta-analysis aimed to validate the prognostic utility of this grading system and identify relevant clinicopathological features. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for relevant studies published between January 1, 2020 and March 5, 2024. Hazard ratios (HRs) with corresponding 95 % confidence intervals (CIs) were pooled to evaluate the effect of IASLC grading on prognosis. Odds ratios with corresponding 95 % CIs were pooled to assess relevant clinicopathological features. Twenty-two studies comprising 12,515 patients with IPA were included. Regarding overall survival, grade 3 adenocarcinomas had a worse prognosis compared with grades 1-2 (HR: 2.26, 95 % CI: 1.79-2.85, P<0.001), grade 1 (HR: 4.75, 95 % CI: 2.61-8.66, P<0.001), or grade 2 (HR: 1.71, 95 % CI: 1.28-2.29, P<0.001). Considering recurrence-free survival, grade 3 tumors had a higher recurrence risk than grades 1-2 (HR: 1.92, 95 % CI: 1.53-2.41, P<0.001), grade 1 (HR: 4.43, 95 % CI: 2.91-6.73, P<0.001), or grade 2 (HR: 1.67, 95 % CI: 1.33-2.10, P<0.001). In the subgroup analysis of stage I patients, grade 3 tumors exhibited a similarly poor prognosis. In addition, grade 3 adenocarcinomas were associated with aggressive clinicopathological features. This study demonstrated that the IASLC grading system is a robust predictor of prognostic stratification in patients with IPA, and warrants further promotion and worldwide implementation.
2020年，国际肺癌研究协会（IASLC）推出了一种新的浸润性肺腺癌（IPA）分级系统。这项荟萃分析旨在验证该分级系统的预后效用，并确定相关的临床病理特征。检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库中2020年1月1日至2024年3月5日期间发表的相关研究。汇总具有相应95%置信区间（CI）的风险比（HR），以评估IASLC分级对预后的影响。汇总具有相应95%CI的比值比，以评估相关的临床病理特征。纳入了22项研究，共12515例IPA患者。关于总生存期，3级腺癌的预后比1-2级（HR：2.26，95%CI：1.79-2.85，P<0.001）、1级（HR：4.75，95%CI：2.61-8.66，P<0.001）或2级（HR：1.71，95%CI：1.28-2.29，P<0.001）更差。考虑无复发生存期，3级肿瘤的复发风险高于1-2级（HR：1.92，95%CI：1.53-2.41，P<0.001）、1级（HR：4.43，95%CI：2.91-6.73，P<0.001）或2级（HR：1.67，95%CI：1.33-2.10，P<0.001）。在I期患者的亚组分析中，3级肿瘤的预后同样较差。此外，3级腺癌与侵袭性临床病理特征相关。本研究表明，IASLC分级系统是IPA患者预后分层的有力预测指标，值得进一步推广并在全球范围内应用。
