Pulmonary adenocarcinoma with high-grade fetal adenocarcinoma component has a poor prognosis, comparable to that of micropapillary adenocarcinoma
Pulmonary adenocarcinoma with high-grade fetal adenocarcinoma component has a poor prognosis, comparable to that of micropapillary adenocarcinoma
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DOI：
10.1038/s41379-018-0057-z
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发表时间：
2018-09-01
期刊：
影响因子：
7.5
通讯作者：
Yokose, Tomoyuki
中科院分区：
文献类型：
--
作者：
Suzuki, Masaki;Nakatani, Yukio;Yokose, Tomoyuki
胎儿腺癌是肺腺癌的一种罕见变异，分为低级别和高级别两种类型。高级别胎儿腺癌的预后比低级别胎儿腺癌差，但高级别胎儿腺癌与常规肺腺癌之间的预后差异尚不清楚。我们回顾了 3719 例手术切除的原发性肺癌的组织切片，发现 53 例肺癌具有高级别胎儿腺癌成分。我们分析了它们的临床病理学和免疫组织化学特征，并对具有胎儿型成分的腺癌进行了预后分析。我们进一步分析了具有胎儿型成分的腺癌与不具有胎儿型成分的传统腺癌之间的预后差异。具有胎儿型成分的肺癌主要发生在有吸烟史的老年男性中。 29 名患者为 I 期疾病，13 名患者为 II 期，11 名患者为 III 期。胎儿型组织学合并常规型腺癌（41例）、鳞状细胞癌（5例）、大细胞神经内分泌癌（5例）、肠腺癌（2例）、小细胞癌（1例）。胎儿型成分显示甲胎蛋白（39%）、磷脂酰肌醇蛋白聚糖-3（37%）和SALL4（17%）免疫阳性。胎儿型为主型和胎儿型非为主型患者的 5 年总生存率分别为 44% 和 56%（P = 0.962）。鳞屑状腺癌、腺泡状腺癌、乳头状腺癌、实性腺癌和微乳头状腺癌、侵袭性粘液腺癌和胎儿型腺癌的 5 年总生存率分别为 94%、82%、77%、69%、57%、83% 和 41%（P < 0.001）。单变量和多变量分析显示，除微乳头状为主的亚型外，具有胎儿型成分的腺癌的总生存率显着低于其他组织学亚型。我们的研究表明，具有胎儿型成分的腺癌的预后较差，与微乳头状腺癌的预后相当。肺腺癌中存在高级别胎儿腺癌成分是重要的预后标志。
Fetal adenocarcinoma is a rare variant of lung adenocarcinoma, which is subcategorized into low-grade and high-grade forms. High-grade fetal adenocarcinoma confers worse prognosis than low-grade fetal adenocarcinoma, but the prognostic differences between high-grade fetal adenocarcinoma and conventional lung adenocarcinoma are unknown. We reviewed tissue sections of 3719 cases of surgically resected primary lung cancers and found 53 lung cancers with a high-grade fetal adenocarcinoma component. We analyzed their clinicopathological and immunohistochemical features, and performed a prognostic analysis of adenocarcinomas with the fetal-type component. We further analyzed the prognostic differences between adenocarcinomas with the fetal-type component and conventional adenocarcinomas without the fetal-type component. Lung cancers with the fetal-type component predominantly occurred in elderly men with a smoking history. Twenty-nine patients had stage I disease, 13 patients had stage II, and 11 patients had stage III. The fetal-type histology was combined with conventional-type adenocarcinoma (41 cases), squamous cell carcinoma (5 cases), large cell neuroendocrine carcinoma (5 cases), enteric adenocarcinoma (2 cases), and small cell carcinoma (1 case). The fetal-type component showed immunopositivity for alpha-fetoprotein (39%), glypican-3 (37%), and SALL4 (17%). The 5-year overall survivals of fetal-type-predominant and fetal-type-nonpredominant patients were 44 and 56%, respectively (P = 0.962). The 5-year overall survivals of lepidic-, acinar-, papillary-, solid-, and micropapillary-predominant adenocarcinomas, invasive mucinous adenocarcinomas, and adenocarcinomas with the fetal-type component were 94, 82, 77, 69, 57, 83, and 41%, respectively (P < 0.001). Univariate and multivariate analyses showed that adenocarcinomas with the fetal-type component had a significantly lower overall survival rate than the other histological subtypes, except for the micropapillary-predominant subtype. Our study demonstrated that adenocarcinomas with the fetal-type component had a poor prognosis that was comparable to that of micropapillary adenocarcinoma. The presence of the high-grade fetal adenocarcinoma component in lung adenocarcinomas is an important prognostic marker.