Bronchioloalveolar Carcinoma (Lepidic Growth) Component Is a More Useful Prognostic Factor than Lymph Node Metastasis
Bronchioloalveolar Carcinoma (Lepidic Growth) Component Is a More Useful Prognostic Factor than Lymph Node Metastasis
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DOI：
10.1097/jto.0b013e3181ad8631
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发表时间：
2009-08-01
影响因子：
20.4
通讯作者：
Noguchi, Masayuki
中科院分区：
文献类型：
--
作者：
Anami, Yoichi;Iijima, Tatsuo;Noguchi, Masayuki
导读：虽然已经报道了许多预测肺癌患者生存的因素，但没有比较研究试图确定那些对实际医学最重要的因素。方法：我们对1993年至2000年间在日本东京国立癌症中心医院（National Cancer Center Hospital, Tokyo, Japan）接受直径小于2cm的腺癌完全切除术的139例患者进行了回顾性分析。测定mb - i标记指数（LI）、癌胚抗原（CEA）、p53、p27、表皮生长因子受体（EGFR）、磷酸化EGFR （pEGFR）、Cox-2、神经元蛋白、γ - H2AX和甲状腺转录因子-1 （TTF-1）的免疫组化染色、微乳头状形态的患病率、细支气管肺泡细胞癌（BAC）或鳞状生长（LG）成分的比例，并比较其作为肺腺癌预后因素的意义。结果：单因素分析显示，淋巴结转移（p- n状态）、BAC/LG成分、血管浸润（p- v状态）、mb - i LI、pEGFR和CEA具有预后意义（p- n状态：p < 0.0001, BAC/LG:p = 0.0005， p- v状态：0.002,mb - i LI: p = 0.005, pEGFR: p = 0.024, CEA: p = 0.049）。多因素分析显示，只有p- n状态（p = 0.013）具有预后意义。然而，BAC/LG成分（p = 0.051）比p- n状态在具有BAC/LG成分的混合性腺癌中是更可靠的预后因素。结论：与其他免疫组织化学和组织病理学因素相比，BAC/LG成分对肺小腺癌的预后具有独立可靠的影响，特别是对于主要的组织学亚型（腺癌混合亚型与BAC/LG）， BAC/LG成分的预后比淋巴结转移更可靠。
Introduction: Although many factors predictive of patient survival have been reported for lung cancer, no comparative studies have attempted to determine those that are most significant for practical medicine.Methods: We conducted a retrospective review of 139 patients who underwent complete resection of adenocarcinomas less than 2 cm in diameter between 1993 and 2000 at the National Cancer Center Hospital (Tokyo, Japan). The MIB-I labeling index (LI), immuno-histochemical staining for carcinoembryonic antigen (CEA), p53, p27, epidermal growth factor receptor (EGFR), phosphorylated-EGFR (pEGFR), Cox-2, neuronatin, gamma H2AX, and thyroid transcription factor-1 (TTF-1), the prevalence of a micropapillary pattern, and the ratio of the bronchioloalveolar cell carcinoma (BAC) or lepidic growth (LG) component were determined, and their significance as prognostic factors for lung adenocarcinoma was compared.Results: Univariate analysis showed that lymph node metastasis (p-N status), BAC/LG component, vascular invasion (p-V status), MIB-I LI, pEGFR, and CEA were prognostically significant (p-N status:p < 0.0001, BAC/LG:p = 0.0005, p-V status: 0.002, MIB-I LI: p = 0.005, pEGFR: p = 0.024, and CEA: p = 0.049). Multivariate analysis showed that only p-N status (p = 0.013) was of prognostic significance. However, BAC/LG component (p = 0.051) was a more reliable prognostic factor than p-N status in mixed adenocarcinoma with a BAC/LG component.Conclusion: In comparison with other immunohistochemical and histopathologic factors, BAC/LG component is independently and reliably prognostic for small adenocarcinoma of the lung, and, in particular, for the major histologic subtype (adenocarcinoma mixed Subtype with BAC/LG), BAC/LG component is more reliably prognostic than lymph node metastasis.