Prognostic Impact of Intra-alveolar Tumor Spread in Pulmonary Adenocarcinoma
Prognostic Impact of Intra-alveolar Tumor Spread in Pulmonary Adenocarcinoma
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DOI：
10.1097/pas.0000000000000409
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发表时间：
2015-06-01
影响因子：
5.6
通讯作者：
Weichert, Wilko
中科院分区：
文献类型：
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作者：
Warth, Arne;Muley, Thomas;Weichert, Wilko
一般说来，肿瘤扩散是决定几乎所有恶性肿瘤预后的最重要因素。就潜在的肿瘤扩散途径而言，肺癌是独一无二的，因为除了肿瘤细胞的血管、结节和远处扩散外，也可能发生通过空气空间的肿瘤扩散(STA)。然而，STAS的形态标准及其对预后的影响尚未确定。我们评估了一系列569例切除的肺腺癌(ADC)，以确定局限性和广泛性STA的预先定义的形态标准，并将我们的发现与临床、形态、分子和结果数据相关联。大约一半的ADC存在有限的(21.6%)或广泛的(29%)STAS。科技援助的存在和类型与特定的增长模式密切相关(P<；0.001)。在高分期(P<；0.001)、结节阳性(P<；0.001)、有远处转移(P=0.010)的ADC中，STAS的表达更高(P=0.010)。STAS与较低的EGFR(P=0.009)和较高的BRAF(P=0.016)突变率相关。此外，STAS与总体生存率(P=0.020)和疾病总生存率(P=0.004)显著相关，这是一种生长模式，但不是独立于阶段的。我们分析了一种仍然被低估的肺ADC通过空气扩散的肿瘤的形态特征。STAS是一种新的形态预测指标，应在常规诊断评估和报告中进一步验证和考虑实施。
Tumor spread, in general, is the most important factor determining outcome in almost all malignant tumors. Lung tumors are unique with respect to potential routes for tumor dissemination, as apart from vascular, nodal, and distant spread of tumor cells, tumor spread through air spaces (STAS) might also occur. However, morphologic criteria for STAS and its prognostic impact have not been defined yet. We evaluated a series of 569 resected pulmonary adenocarcinomas (ADCs) for predefined morphologic criteria of limited and extensive STAS and correlated our findings with clinical, morphologic, molecular, and outcome data. Limited (21.6%) or extensive (29%) STAS was present in roughly half of all ADCs. The presence and type of STAS was tightly linked to specific growth patterns (P < 0.001). STAS was much more prevalent in high-stage (P < 0.001), nodal-positive (P < 0.001) ADC with distant metastasis (P = 0.010). STAS was associated with lower rates of EGFR (P = 0.009) but higher rates of BRAF (P = 0.016) mutations. Furthermore, STAS was associated with significantly reduced overall (P = 0.020) and diseasefree survival (P = 0.004), which was growth pattern but not stage independent. We analyzed morphologic characteristics of a yet underestimated type of tumor spread of pulmonary ADC through air spaces. STAS is a novel morphologic prognosticator, which should be further validated and considered for implementation in routine diagnostic evaluation and reporting.