Prognostic Significance of Predominant Histologic Pattern and Nuclear Grade in Resected Adenocarcinoma of the Lung Potential Parameters for a Grading System
Prognostic Significance of Predominant Histologic Pattern and Nuclear Grade in Resected Adenocarcinoma of the Lung Potential Parameters for a Grading System
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DOI：
10.1097/jto.0b013e318276274e
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发表时间：
2013-01-01
影响因子：
20.4
通讯作者：
Nicholson, Andrew G.
中科院分区：
文献类型：
--
作者：
von der Thusen, Jan H.;Tham, Yuen S.;Nicholson, Andrew G.
简介：目前，肺腺癌（ADC）尚无商定的组织学分级系统。根据最近更新的共识分类，本研究的目的是评估常规组织学可识别的潜在预后因素，这些因素可用作分级参数。方法：对 IA 至 IIIB 期疾病患者的切除肺 ADC (n = 238) 进行回顾性研究，其中各种组织病理学参数与生存数据相关。使用 Cox 比例风险回归分析这些因素与患者生存率之间的关系。 结果：发现有丝分裂率是一个非常显着的预后标志物 (p = 0.008)，总体核分级 (p < 0.001) 也是如此。 ADC 亚型也被发现具有潜在的重要性，因为鳞屑为主（风险比 0.99，p = 0.023）和实性为主（风险比 1.01，p = 0.003）亚型被发现是独立的（与年龄和肿瘤、淋巴结、转移类别）预后预测因子。肿瘤内的血管侵犯作为负面预后因素具有显着意义 (p = 0.067)。 结论：这项研究不仅表明组织学亚型和有丝分裂率是肺 ADC 的重要预后因素，而且之前描述的其他标准可能对我们的特定患者群体没有用。
Introduction: Currently, no agreed histologic grading system exists for lung adenocarcinomas (ADCs). With a recently updated consensus classification, the aim of this study was to assess potential prognostic factors identifiable on routine histology, which might be used as grading parameters.Methods: A retrospective study of resected pulmonary ADCs (n = 238) in patients with stage IA to IIIB disease was carried out in which various histopathological parameters were correlated with survival data. The relationship between these factors and patient survivability was analyzed using Cox proportional hazards regression.Results: Mitotic rate was found to be a highly significant prognostic marker (p = 0.008), as was overall nuclear grade (p < 0.001). ADC subtyping was also found to be potentially important, as lepidic predominant (hazard ratio 0.99, p = 0.023) and solid predominant (hazard ratio 1.01, p = 0.003) subtypes were found to be independent (to age and tumor, node, metastasis category) prognostic predictors. Vessel invasion within tumor approached significance as a negative prognostic factor (p = 0.067).Conclusions: This study showed not only that histologic subtype and mitotic rate are important prognostic factors in lung ADCs, but also that other criteria described previously may not be useful in our specific patient population.