Does Lung Adenocarcinoma Subtype Predict Patient Survival? A Clinicopathologic Study Based on the New International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Lung Adenocarcinoma Classification
Does Lung Adenocarcinoma Subtype Predict Patient Survival? A Clinicopathologic Study Based on the New International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Lung Adenocarcinoma Classification
复制标题
DOI：
10.1097/jto.0b013e318221f701
复制
发表时间：
2011-09-01
影响因子：
20.4
通讯作者：
Williams, Richard A.
中科院分区：
文献类型：
--
作者：
Russell, Prudence A.;Wainer, Zoe;Williams, Richard A.
简介：肺腺癌是一组异质性肿瘤，预后差异很大，目前的病理分类系统无法很好地预测。 2004年世界卫生组织的分类结果几乎所有临床实践中遇到的肿瘤都被归入混合亚型类别的腺癌。由国际肺癌研究协会、美国胸科学会和欧洲呼吸学会赞助的国际多学科专家小组开发的新分类基于组织形态学亚型，最近已在北美 514 例 I 期肺腺癌系列中得到验证。我们研究了一系列澳大利亚 I、II 和 III 期肺腺癌患者的新分类与患者生存率之间的关系。方法：我们从手术数据库中识别出 1996 年至 2009 年间接受肺腺癌切除术的 210 名患者。两名对患者结果不知情的病理学家根据新分类独立进行组织病理学分型。 Kaplan-Meier 曲线用于计算每个单独的组织病理学亚型/变异体的 5 年生存率。采用单变量和多变量分析来控制已验证的预后因素。结果：我们证实，原位腺癌、微浸润腺癌和鳞屑为主的腺癌的新亚型的 5 年生存率接近 100%，而微乳头为主和粘蛋白为主的实性腺癌的生存率特别差。乳头状为主和腺泡为主的腺癌预后中等。在控制分期后，这种效应仍然存在。结论：根据新的国际肺癌研究协会/美国胸科学会/欧洲呼吸学会分类对肺腺癌进行的分类与 5 年生存率相关。在控制已知的患者预后和肿瘤特征后，这些关系仍然存在。新的分类不仅有利于个体患者护理，而且有利于临床试验和分子研究的更好选择和分层。
Introduction: Lung adenocarcinoma is a heterogeneous group of tumors with a highly variable prognosis, not well predicted by the current pathologic classification system. The 2004 World Health Organization classification results in virtually all tumors encountered in clinical practice being allocated to the adenocarcinoma of mixed subtype category. A new classification developed by an international multidisciplinary expert panel sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society, is based on histomorphologic subtype and has recently been validated in a North American series of 514 stage I lung adenocarcinomas. We investigated the relationship between the new classification and patient survival in a series of Australian patients with stages I, II, and III lung adenocarcinoma.Methods: We identified 210 patients from a surgical database who underwent resection of lung adenocarcinoma from 1996 to 2009. Two pathologists, blinded to patient outcome, independently performed histopathologic subtyping according to the new classification. Kaplan-Meier curves were used to calculate 5-year survival for each separate histopathologic subtype/variant. Univariate and multivariate analyses were undertaken to control for validated prognostic factors.Results: We confirmed that the new subtypes of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic-predominant adenocarcinoma had a 5-year survival approaching 100%, whereas micropapillary-predominant and solid with mucin-predominant adenocarcinomas were associated with particularly poor survival. Papillary-predominant and acinar-predominant adenocarcinomas had an intermediate prognosis. This effect persisted after controlling for stage.Conclusions: Classification of lung adenocarcinoma according to the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification correlated with 5-year survival. These relationships persisted after controlling for known prognostic patient and tumor characteristics. The new classification has advantages not only for individual patient care but also for better selection and stratification for clinical trials and molecular studies.