Histologic Features Associated With Metastatic Potential in Invasive Adenocarcinomas of the Lung
Histologic Features Associated With Metastatic Potential in Invasive Adenocarcinomas of the Lung
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DOI：
10.1097/pas.0b013e31827fcf04
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发表时间：
2013-07-01
影响因子：
5.6
通讯作者：
Burke, Allen
中科院分区：
文献类型：
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作者：
Xu, Lauren;Tavora, Fabio;Burke, Allen
国际肺癌研究协会（IASLC）最近根据组织学模式对肺腺癌进行了重新分类。然而，对于这些肿瘤的分级系统缺乏共识。我们研究了一系列浸润性肺腺癌，并将其组织学特征与淋巴结和远处转移进行了相关性研究。一系列浸润性肺癌切除超过5年的时间进行了回顾性分析和分类的IASLC系统。每种组织学亚型的比例以5%的增量估计，细胞学特征被盲法记录，随后与淋巴结和远处转移相关。125例肿瘤根据主要类型分为：以鳞屑为主（LPA）（n = 9）、腺泡（n = 71）、实体（n = 23）、乳头状（n = 11）和粘液性（n = 11）。腺泡类型是异质性的，筛状亚组（n = 34）与管状亚组（n = 37）相比更可能显示淋巴结转移，并且具有更高的有丝分裂率、坏死率、血管浸润和显著的核仁。粘液性肿瘤为LPA（n = 3）、管状（n = 4）和筛状为主（n = 4）。淋巴结转移率以实体型最高（P = 0.02）。黏液型和实性型远处转移率最高（P < 0.02）。有丝分裂活性（>= 1/HPF）、结缔组织增生>20%、核仁突出、血管浸润、沿着实体生长模式>= 20%与转移潜能独立相关，并被认为是预后不良的组织学特征。3层分级系统将肿瘤分为高分化（主要为LPA、乳头状和管状模式）、中等分化（主要为筛状肿瘤）和低分化（>= 20%实体生长模式）。如果有不良预后的组织学特征，则高分化组的肿瘤升高至中等分化。采用该系统，从高分化、中分化到低分化肿瘤，淋巴结转移率（P < 0.0001）和远处转移率（P = 0.0004）依次递增，分别为40、46和39。应用IASLC分类在这一系列导致腺泡腺癌的优势。为了将肿瘤分为临床相关等级，根据模式（管状，筛状，实性），有丝分裂活性和核特征进行分级是有用的。
The International Association for the Study of Lung Cancer (IASLC) recently reclassified adenocarcinomas of the lung on the basis of histologic patterns. However, there is lack of consensus about a grading system for these tumors. We studied a series of invasive lung adenocarcinomas and correlated histologic features with lymph node and distant metastases. A series of invasive lung carcinomas resected over a 5-year period were retrospectively reviewed and classified by the IASLC system. The proportion of each histologic subtype was estimated at 5% increments, and cytologic features were blindly recorded and subsequently correlated with lymph node and distant metastases. The 125 tumors were classified on the basis of the predominant pattern as lepidic predominant (LPA) (n = 9), acinar (n = 71), solid (n = 23), papillary (n = 11), and mucinous (n = 11). The acinar pattern was heterogenous, in that a cribriform subgroup (n = 34) was significantly more likely to demonstrate lymph node metastases compared with a tubular subgroup (n = 37) and had a higher mitotic rate, rate of necrosis, vascular invasion, and prominent nucleoli. Mucinous tumors were LPA (n = 3), tubular (n = 4), and cribriform predominant (n = 4). The rate of lymph node metastasis was greatest in the solid type (P = 0.02). The rate of distant metastasis was greatest in the mucinous and solid groups (P < 0.02). Mitotic activity (>= 1/HPF), desmoplasia >20% of the tumor, prominent nucleoli, and vascular invasion, along with a solid growth pattern >= 20%, were independently associated with metastatic potential and considered poor prognostic histologic features. A 3-tiered grading system separated tumors into well differentiated (predominantly LPA, papillary, and tubular patterns), moderately differentiated (predominantly cribriform tumors), and poorly differentiated (>= 20% solid growth pattern). Tumors in the well-differentiated group were elevated to moderately differentiated if there were poor prognostic histologic features. Using this system, there was a stepwise increase in the rate of lymph node metastasis (P < 0.0001) and distant metastasis (P = 0.0004) from well-differentiated, moderately differentiated, to poorly differentiated tumors, the rate being 40, 46, and 39, respectively. Application of the IASLC classification in this series resulted in a predominance of acinar adenocarcinomas. To stratify tumors into clinically relevant grades, grading by pattern (tubular, cribriform, solid), mitotic activity, and nuclear features is useful.