Comprehensive pathological analyses in lung squamous cell carcinoma: single cell invasion, nuclear diameter, and tumor budding are independent prognostic factors for worse outcomes.
Comprehensive pathological analyses in lung squamous cell carcinoma: single cell invasion, nuclear diameter, and tumor budding are independent prognostic factors for worse outcomes.
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DOI：
10.1097/jto.0000000000000253
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发表时间：
2014-08
期刊：
影响因子：
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通讯作者：
Travis WD
中科院分区：
文献类型：
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作者：
Kadota K;Nitadori J;Woo KM;Sima CS;Finley DJ;Rusch VW;Adusumilli PS;Travis WD
对于肺鳞状细胞癌，除病理分期外，尚无公认为预后因素的病理结果。在其他癌症中，肿瘤萌发和核分级被认为是预后较差的因素。在这项研究中，我们调查了病理结果是否可以决定肺鳞状细胞癌的预后。回顾1999-2009年手术切除的孤立性肺鳞状细胞癌患者的所有可用的肿瘤切片(n=485；I/II/III期，281/136/68)。评估肿瘤的分化程度、亚型(角化型、非角化型、基底型、乳头状生长和透明细胞特征)、肿瘤巢大小(肿瘤萌芽和单细胞侵袭)和核分级(核直径和有丝分裂)。总体生存(OS)采用Kaplan-Meier方法(按病理分期分层)，分组差异采用分层对数检验和Cox比例风险模型。与无单细胞侵袭的患者相比，OS显著降低(整个肿瘤的p=0.002，肿瘤边缘的p=0.001)，有大核与小核的患者(p=0.011)，以及高级别与低级别肿瘤萌芽的患者(p<；0.001，总的p=0.007)。在多因素分析中，单细胞侵袭(危险比[HR]，1.47~1.49)、核直径(HR，1.09~1.33)和肿瘤萌芽(HR，1.04)是影响OS预后的独立因素。然而，包括角化型、非角化型、基底型和透明细胞亚型在内的组织学亚型对预后没有意义。病理因素有助于对肺鳞癌患者的预后进行分层。
For lung squamous cell carcinomas, there are no pathological findings that have been universally accepted as prognostic factors, with the exception of pathological stage. Tumor budding and nuclear grade have been recognized as a poor prognostic factor in other carcinomas. In this study, we investigated whether pathological findings could determine prognosis in lung squamous cell carcinomas. All available tumor slides from patients with surgically resected, solitary lung squamous cell carcinomas (1999–2009) were reviewed (n = 485; stage I/II/III, 281/136/68). Tumors were evaluated for differentiation, subtypes (keratinizing, non-keratinizing, basaloid pattern, papillary growth, and clear cell feature), tumor nest size (tumor budding and single cell invasion), and nuclear grade (nuclear diameter and mitosis). Overall survival (OS) was estimated using the Kaplan-Meier method (stratified by pathological stage) and group differences were investigated using the stratified log-rank test and the Cox proportional hazards model. OS was significantly decreased in patients with vs. without single cell invasion (p = 0.002 for the entire tumor and p = 0.001 for tumor edge), with large vs. small nuclei (p = 0.011), and with high vs. low grade tumor budding (p < 0.001 for maximum and p = 0.007 for total). In multivariate analyses, single cell invasion (hazard ratio [HR], 1.47–1.49), nuclear diameter (HR, 1.09–1.33) and tumor budding (HR, 1.04) were independent prognostic factors of OS. However, histologic subtyping including keratinizing, nonkeratinizing, basaloid, and clear cell subtypes did not show prognostic significance. Pathological factors can help stratify prognosis in patients with lung squamous cell carcinomas.