A Novel Radiopathological Grading System to Tailor Recurrence Risk for Pathologic Stage IA Lung Adenocarcinoma
A Novel Radiopathological Grading System to Tailor Recurrence Risk for Pathologic Stage IA Lung Adenocarcinoma
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一种新的放射病理学分级系统，可定制病理 IA 期肺腺癌的复发风险
DOI：
10.1053/j.semtcvs.2022.06.003
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发表时间：
2022
影响因子：
2.5
通讯作者：
Wen-Zhao Zhong
中科院分区：
文献类型：
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作者：
Zhen-Bin Qiu;Meng-Min Wang;Jin-Hai Yan;Chao Zhang;Yi-Long Wu;Sheng Zhang;Wen-Zhao Zhong
目的：验证病理分级系统在IA期肺腺癌(LUAD)诊断中的有效性，并探讨结合术前X线征象是否有助于提高对复发的鉴别能力。我们回顾了2012年1月至2019年12月广东省人民医院收治的510例IA期LUAD患者。根据国际肺癌研究协会(IASLC)的病理分期系统对每个病例进行病理分级。采用Kaplan-Meier曲线评估复发分层的威力。采用一致性指数(C-Index)和受试者工作特征曲线(ROC)评价不同分级系统对复发判别的临床应用价值。IASLC分级越低，无复发生存率越高(P<；0.0001)，其中II级和III级之间差异有统计学意义(P=0.119)。通过结合IASLC分级系统和放射学特征，我们发现RFS率随着新的放射病理学(RP)分级系统的增加而降低(P<；0.0001)。根据RP分级系统，任意两组之间的RFS曲线差异有统计学意义(RP I级与RP II级，P=0.007；RP I级与RP III级，P=0.0001；RP II级与RP III级，P=0.0003)。与IASLC分级系统相比，RP分级系统显著提高了复发生存判别率(C指数：0.822；曲线下面积：0.845)。将影像特征与病理分级系统相结合，提高了IA期LUAD术后复发鉴别的效率，有助于指导后续治疗。
To validate the efficiency of pathologic grading system in pathologic stage IA lung adenocarcinoma (LUAD), and explore whether integrating preoperative radiological features would enhance the performance of recurrence discrimination. We retrospectively collected 510 patients with resected stage IA LUAD between January 2012 and December 2019 from Guangdong Provincial People's Hospital (GDPH). Pathologic grade classification of each case was based on the International Association for the Study of Lung Cancer (IASLC) pathologic staging system. Kaplan-Meier curves was used to assess the power of recurrence stratification. Concordance index (C-Index) and receiver operating characteristic curves (ROC) were used for evaluating the clinical utility of different grading systems for recurrence discrimination. Patients of lower IASLC grade showed improved recurrence-free survival (RFS) (P < 0.0001) where numerically difference was found between grade II and grade III (P = 0.119). By integrating the IASLC grading system and radiological feature, we found the RFS rate decreased as the novel radiopathological (RP) grading system increased (P < 0.0001). The difference of RFS curves between any 2 groups as per the RP grading system was statisticallysignificant (RP grade I vs RP grade II, p = 0.007; RP grade I vs RP grade III, P < 0.0001; RP grade II vs RP grade III, P = 0.0003). Compared with the IASLC grading system, the RP grading system remarkably improved recurrence survival discrimination (C-index: 0.822; area under the curve, 0.845). Integrating imaging features into pathologic grading system enhanced the efficiency of recurrence discrimination for resected stage IA LUAD and might help conduct subsequent management.