A grading system combining architectural features and mitotic count predicts recurrence in stage I lung adenocarcinoma.
A grading system combining architectural features and mitotic count predicts recurrence in stage I lung adenocarcinoma.
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DOI：
10.1038/modpathol.2012.58
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发表时间：
2012-08
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IASLC/ATS/ERS最近提出了一种新的肺腺癌分类。我们研究了核特征是否可以对预后亚群进行分层。本文回顾了485例I期肺腺癌患者的载玻片。我们评估了核直径、核非典型性、核/细胞质比、染色质模式、核仁突出程度、核内包涵体、有丝分裂计数/10高倍视场（HPF）或2.4 mm2，以及非典型性有丝分裂。根据IASLC/ATS/ERS分级将肿瘤分为组织学亚型，并根据结构分级分为低（原位腺癌、微创腺癌或鳞状显性）、中（乳头状或腺泡状）和高（微乳头状或实状）。Log-rank检验和Cox回归模型评估临床病理因素预测无复发概率的能力。在单因素分析中，核直径（p=0.007）、核非典型性（p=0.006）、有丝分裂计数（p<0.001）和非典型性有丝分裂（p<0.001）是复发的重要预测因素。有丝分裂计数高（≥5/10HPF: n=175）的患者无复发概率最低（5年无复发概率=73%），其次是中等（2-4/10HPF: n=106, 80%），低（0-1/10HPF: n=204, 91%, p<0.001）。结合建筑/有丝分裂分级系统分层患者结局（p<0.001）：低分级（建筑分级低有丝分裂计数，中等分级低有丝分裂计数：n=201, 5年无复发概率=92%），中级分级（建筑分级中有丝分裂计数：n=206, 78%），高分级（建筑分级中有丝分裂计数：n=78, 68%）。将有丝分裂计数加入建筑分级的优点是将中等建筑分级的患者分为预后不同的两类（p=0.001）。在调整了包括性别、分期、胸膜/淋巴血管浸润和坏死在内的临床病理因素后，有丝分裂计数不是复发的独立预测因子（p=0.178）。然而，在调整临床因素后，高建筑/有丝分裂分级的患者的复发风险仍然显著增加（高vs低：p=0.005）。我们提出这种结合建筑/有丝分裂分级的肺腺癌作为一种实用的方法，可以应用于日常实践。
The IASLC/ATS/ERS has recently proposed a new lung adenocarcinoma classification. We investigated whether nuclear features can stratify prognostic subsets. Slides of 485 stage I lung adenocarcinoma patients were reviewed. We evaluated nuclear diameter, nuclear atypia, nuclear/cytoplasmic ratio, chromatin pattern, prominence of nucleoli, intranuclear inclusions, mitotic count/10 high-power fields (HPF) or 2.4 mm2, and atypical mitoses. Tumors were classified into histologic subtypes according to the IASLC/ATS/ERS classification and grouped by architectural grade into low (adenocarcinoma in situ, minimally invasive adenocarcinoma or lepidic predominant), intermediate (papillary or acinar), and high (micropapillary or solid). Log-rank tests and Cox regression models evaluated the ability of clinicopathologic factors to predict recurrence-free probability. In univariate analyses, nuclear diameter (p=0.007), nuclear atypia (p=0.006), mitotic count (p<0.001), and atypical mitoses (p<0.001) were significant predictors of recurrence. The recurrence-free probability of patients with high mitotic count (≥5/10HPF: n=175) was the lowest (5-year recurrence-free probability=73%), followed by intermediate (2–4/10HPF: n=106, 80%), and low (0–1/10HPF: n=204, 91%, p<0.001). Combined architectural/mitotic grading system stratified patient outcomes (p<0.001): low grade (low architectural grade with any mitotic count and intermediate architectural grade with low mitotic count: n=201, 5-year recurrence-free probability=92%), intermediate grade (intermediate architectural grade with intermediate-high mitotic counts: n=206, 78%), and high grade (high architectural grade with any mitotic count: n=78, 68%). The advantage of adding mitotic count to architectural grade is in stratifying patients with intermediate architectural grade into two prognostically distinct categories (p=0.001). After adjusting for clinicopathologic factors including sex, stage, pleural/lymphovascular invasion, and necrosis, mitotic count was not an independent predictor of recurrence (p=0.178). However, patients with the high architectural/mitotic grade remained at significantly increased risk of recurrence (high vs. low: p=0.005) after adjusting for clinical factors. We proposed this combined architectural/mitotic grade for lung adenocarcinoma as a practical method that can be applied in routine practice.
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影响因子：
6.4
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