Prognostic significance of grading in lung adenocarcinoma.
Prognostic significance of grading in lung adenocarcinoma.
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DOI：
10.1002/cncr.24831
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发表时间：
2010-02-01
期刊：
影响因子：
6.2
通讯作者：
Chirieac, Lucian R.
中科院分区：
文献类型：
--
作者：
Barletta, Justine A.;Yeap, Beow Y.;Chirieac, Lucian R.
虽然分级对许多肿瘤类型具有预后意义，但肺腺癌的临床意义分级系统尚未建立。本研究的目的是评估肿瘤分级系统中的组织学特征，建立与总生存期相关性最强的最佳临界值，并建立一个结合组织病理学特征的分级系统，我们发现这些特征对肺腺癌患者的预后具有重要意义。我们研究了85例连续的肺腺癌患者，并评估了实性模式的百分比（作为肿瘤结构的反映），细胞学异常的程度和核分裂计数。在单因素分析中，总生存率与性别（P=0.045）、年龄（P=0.0008）、肿瘤状态（P<0.0001）、淋巴结状态（P=0.02）、实性模式（P=0.046）和细胞学异常（P=0.01）显著相关，但与核分裂计数无关（P=0.26）。基于最佳临界值，我们发现实性模式≥ 90%和严重细胞学异常是预后不良的最佳鉴别因素。在单变量分析中，分级评分（计算为结构评分和细胞学分级评分之和（2=高分化，3=中度分化，4=低分化））是总生存期的重要预测因素（高、中度和低分化腺癌的中位总生存期分别为72.4、39.5和8.7个月，P=0.0001）。此外，在多因素分析中，分级是生存率的独立预测因素（P=0.002）。我们描述了一个分级系统，它结合了实性模式的百分比和细胞学异常的程度，这是肺腺癌患者生存的独立预测因素。
Although grading has prognostic significance for many tumor types, a prognostically significant grading system for lung adenocarcinoma has not yet been established. The aim of this study was to evaluate histologic characteristics included in tumor grading systems, establish optimal cutoff values that have the strongest association with overall survival, and develop a grading system incorporating the histopathologic characteristics that we found to have prognostic significance in patients with lung adenocarcinoma. We studied lung adenocarcinomas from 85 consecutive patients, and evaluated the percentage of solid pattern (as a reflection of tumor architecture), the degree of cytologic atypia, and the mitotic count. In univariate analysis, overall survival was associated significantly with sex (P=0.045), age (P=0.0008), tumor status (P<0.0001), node status (P=0.02), solid pattern (P=0.046) and cytologic atypia (P=0.01), but not with mitotic count (P=0.26). Based on optimal cutoff values, we found that a solid pattern ≥ 90% and severe cytologic atypia were the best discriminators of worse outcome. A grading score, computed as the sum of the architecture score and cytologic atypia score (2=well differentiated, 3=moderately differentiated, 4=poorly differentiated), was a significant predictor of overall survival in univariate analysis (median overall survival times 72.4, 39.5, and 8.7 months for well, moderately and poorly differentiated adenocarcinoma, respectively P=0.0001). Moreover, grading was an independent predictor of survival in multivariate analysis (P=0.002). We describe a grading system that incorporates the percentage of solid pattern and degree of the cytologic atypia that is an independent predictor of survival in patients with lung adenocarcinoma.
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影响因子：
254.7
作者：
Jemal, Ahmedin;Siegel, Rebecca;Thun, Michael J.
通讯作者：
Thun, Michael J.
影响因子：
5.6
作者：
Miyoshi, T;Satoh, Y;Ishikawa, Y
通讯作者：
Ishikawa, Y
DOI：
10.1093/jnci/djn383
发表时间：
2008-12-17
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Yabroff, K. Robin;Bradley, Cathy J.;Feuer, Eric J.
通讯作者：
Feuer, Eric J.
DOI：
10.1093/jnci/djn389
发表时间：
2008-12-03
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Jemal A;Thun MJ;Ries LA;Howe HL;Weir HK;Center MM;Ward E;Wu XC;Eheman C;Anderson R;Ajani UA;Kohler B;Edwards BK
通讯作者：
Edwards BK
影响因子：
4.6
作者：
Riquet, M;Foucault, C;Danel, C
通讯作者：
Danel, C