Lung adenocarcinoma with mixed bronchioloalveolar and invasive components - Clinicopathological features, subclassification by extent of invasive foci, and immunohistochemical characterization
Lung adenocarcinoma with mixed bronchioloalveolar and invasive components - Clinicopathological features, subclassification by extent of invasive foci, and immunohistochemical characterization
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DOI：
10.1097/00000478-200307000-00009
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发表时间：
2003-07-01
影响因子：
5.6
通讯作者：
Hirohashi, S
中科院分区：
文献类型：
--
作者：
Terasaki, H;Niki, T;Hirohashi, S
相当比例的小肺腺癌由两部分组成：细支气管肺泡癌（BAC）和浸润性癌。本研究的目的是比较其与BAC及无BAC的浸润性癌的临床病理特征，并根据浸润灶的范围来定义“早期浸润性”病变。我们回顾了484例切除的肺腺癌病变，根据肿瘤生长模式将其分为三组：1组（n = 102， BAC）， 2组（n = 216， BAC和浸润性癌组成的腺癌），3组（n = 166，不含BAC成分的浸润性腺癌）。2组根据浸润面积进一步细分：2a组（n = 54）， BAC浸润灶小于等于5mm；2b组（n = 162）， BAC伴浸润性病灶bb0 5 mm。比较两组患者的临床病理特征、Ki-67和p53的表达以及层粘连蛋白-5（一种推定的肿瘤侵袭标志物）的表达。各组血管、淋巴、胸膜浸润阳性率分别为0%、0%、0%；2a组为5.5%、14.8%和1.9%；2b组45.7%、41.4%、25.9%；3组分别为84.9%、61.4%、60.8%。值得注意的是，2a组和1组均未发生淋巴结转移，而2b组和3组的淋巴结转移率分别为24.1%和47.0%。Ki-67平均标记指数、p53过表达频率、laminin-5过表达频率从1组（11%、4%、0%）到2a组（16%、20%、7%）到2b组（24%、41%、23%）再到3组（35%、38%、38%）均呈上升趋势。相比之下，当病变按大小细分时，没有明显的差异。根据ki -67阳性肿瘤细胞的分布模式，将病变分为边缘型（63%）和非边缘型（37%）两组。后者的标记指数显著高于前者。边缘型比例从1组（85%）、2a组（87%）、2b组（55%）、3组（19%）明显下降。2组病变特征介于BAC和浸润性腺癌之间。根据浸润区域的范围，我们能够定义一个混合型腺癌亚组（2a组），由于其血管、淋巴和胸膜浸润率低，且无淋巴结累及，因此可视为早期浸润性癌。
A significant proportion of small lung adenocarcinomas consists of two components: bronchioloalveolar carcinoma (BAC) and invasive carcinoma. The purpose of this study was to compare their clinicopathologic features with those of BAC and those of invasive cancer without BAC, and to define "early invasive" lesions based on the extent of invasive foci. We reviewed 484 lesions of resected lung adenocarcinoma and classified them into three groups according to tumor growth pattern: group 1 (n = 102, BAC), group 2 (n = 216, adenocarcinoma consisting of BAC and invasive carcinoma), and group 3 (n = 166, invasive adenocarcinoma without BAC component). Group 2 was further subdivided according to the extent of the invasive area: group 2a (n = 54), BAC with invasive foci less than or equal to5 mm; group 2b (n = 162), BAC with invasive foci >5 mm. These groups were compared with regard to their clinicopathologic features, expression of Ki-67 and p53, and expression of laminin-5, a putative marker for tumor invasion. The positivity rates of vascular, lymphatic, and pleural invasion in each group were as follows: 0%, 0%, and 0% in group 1; 5.5%, 14.8%, and 1.9% in group 2a; 45.7%, 41.4%, and 25.9% in group 2b; and 84.9%, 61.4%, and 60.8% in group 3. Notably, no lymph node metastasis occurred in either group 2a or group 1, but it was observed in 24.1% of group 2b and 47.0% of group 3. The mean Ki-67 labeling index, the frequency of p53 overexpression, and the frequency of laminin-5 overexpression increased from group 1 (11%, 4%, and 0%) to group 2a (16%, 20%, and 7%) to group 2b (24%, 41%, and 23%) to group 3 (35%, 38%, and 38%). In contrast, no clear differences were observed when lesions were subdivided according to size. Based on the distribution pattern of Ki-67-positive tumor cells, lesions were classified into two groups: marginal type (63%) and nonmarginal type (37%). The latter showed a significantly higher labeling index than the former. Moreover, the proportion of the marginal type clearly decreased from group 1 (85%) and group 2a (87%) to group 2b (55%) to group 3 (19%). Group 2 lesions showed characteristics intermediate between the BAC and invasive adenocarcinoma. According to the extent of the invasive area, we were able to define a subgroup of mixed-type adenocarcinomas (group 2a) that could be regarded as early invasive cancer because they showed low rates of vascular, lymphatic, and pleural invasion, and no nodal involvement.