New Pathologic Classification of Lung Cancer: Relevance for Clinical Practice and Clinical Trials
New Pathologic Classification of Lung Cancer: Relevance for Clinical Practice and Clinical Trials
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DOI：
10.1200/jco.2012.46.9270
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发表时间：
2013-03-10
影响因子：
45.3
通讯作者：
Riely, Gregory J.
中科院分区：
文献类型：
--
作者：
Travis, William D.;Brambilla, Elisabeth;Riely, Gregory J.
我们总结了2011年国际肺癌研究协会/美国胸科学会/欧洲呼吸学会（IASLC/ATS/ERS）肺腺癌分类导致的肺癌病理分类的重大变化。该分类由代表IASLC、ATS和ERS的国际核心专家小组与肿瘤学家/肺病学家、病理学家、放射科医生、分子生物学家和胸外科医生共同制定。由于70%的肺癌患者处于晚期，因此采用特定术语和标准进行小活检和细胞学检查的新方法侧重于区分鳞状细胞癌和腺癌以及EGFR突变和ALK重排的分子检测。由于缺乏明确的鳞状细胞癌或腺癌形态，先前分类为非小细胞癌的肿瘤（未另行说明）应通过使用有限的免疫组织化学检查进一步分类，以保存组织进行分子检测。术语“细支气管肺泡癌”和“混合亚型腺癌”已停止使用。对于切除的腺癌，原位腺癌和微创腺癌的新概念定义了患者，如果他们接受完全切除，将有100%的无病生存。浸润性腺癌现在使用综合的组织学亚型（包括鳞片状、腺泡状、乳头状和实性）后，通过主要模式进行分类;微乳头状被添加为预后不良的新组织学亚型。以前的粘液性细支气管肺泡癌现在被称为“浸润性粘液腺癌”。“由于肺癌领域现在正在迅速发展，新的进展频繁发生，特别是在分子竞技场，这种分类提供了一个急需的病理诊断标准，不仅为病人护理，而且为临床试验和TNM分类。J Clin Oncol 31：992-1001. (C)2013年美国临床肿瘤学会
We summarize significant changes in pathologic classification of lung cancer resulting from the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) lung adenocarcinoma classification. The classification was developed by an international core panel of experts representing IASLC, ATS, and ERS with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. Because 70% of patients with lung cancer present with advanced stages, a new approach to small biopsies and cytology with specific terminology and criteria focused on the need for distinguishing squamous cell carcinoma from adenocarcinoma and on molecular testing for EGFR mutations and ALK rearrangement. Tumors previously classified as non-small-cell carcinoma, not otherwise specified, because of the lack of clear squamous or adenocarcinoma morphology should be classified further by using a limited immunohistochemical workup to preserve tissue for molecular testing. The terms "bronchioloalveolar carcinoma" and "mixed subtype adenocarcinoma" have been discontinued. For resected adenocarcinomas, new concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma define patients who, if they undergo complete resection, will have 100% disease-free survival. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic, acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype with poor prognosis. Former mucinous bronchioloalveolar carcinomas are now called "invasive mucinous adenocarcinoma." Because the lung cancer field is now rapidly evolving with new advances occurring on a frequent basis, particularly in the molecular arena, this classification provides a much needed standard for pathologic diagnosis not only for patient care but also for clinical trials and TNM classification. J Clin Oncol 31:992-1001. (C) 2013 by American Society of Clinical Oncology