Clinical Relevance of Different Papillary Growth Patterns of Pulmonary Adenocarcinoma
Clinical Relevance of Different Papillary Growth Patterns of Pulmonary Adenocarcinoma
复制标题
DOI：
10.1097/pas.0000000000000622
复制
发表时间：
2016-06-01
影响因子：
5.6
通讯作者：
Weichert, Wilko
中科院分区：
文献类型：
--
作者：
Warth, Arne;Muley, Thomas;Weichert, Wilko
肺腺癌（ADC）的生长模式具有较高的预后影响，并被认为是该实体的一种新的分类系统。然而，特别是对于乳头型，关于患病率，临床相关性和预后影响的不同数据已被报道。通过评估674例切除的肺ADC，包括308例乳头状成分和101例乳头状为主的病例，我们记录了乳头状生长模式的形态组成的差异，并描绘了3种不同的类型。不同类型与病理和临床资料包括生存率相关。3型乳头状肿瘤伴任何或主要乳头状生长与肺泡腔广泛扩散、高增殖、高分期、低EGFR突变率和吸烟相关，而1型乳头状肿瘤表现出相反的相关性。乳头状生长的亚分类揭示了总体和无病生存期的类型特异性相关性（1型无病生存期：67.1个月，2型：56.8个月，3型：49.9个月，P = 0.025）。任何乳头状3型模式的存在是总生存率较差的主要模式独立预测因子（风险比= 2.5，P = 0.02）。对于肺ADC的未来分级系统，将乳头状生长分类为1个单一类别可能是不够的，因为这种模式包含具有不同预后的肿瘤的异质混合。我们建议应分离乳头状模式类型，以进一步提高ADC生长模式分析的预后能力。
Growth patterns of pulmonary adenocarcinoma (ADC) have high prognostic impact and are accepted as a novel classification system for this entity. However, specifically for the papillary pattern, divergent data with respect to prevalence, clinical associations, and prognostic impact have been reported. By evaluating 674 resected pulmonary ADCs containing 308 cases with a papillary component and 101 papillary predominant cases, we documented differences in the morphologic composition of papillary growth patterns and delineated 3 different types. The different types were correlated with pathologic and clinical data including survival. Type 3 papillary cases with any or predominant papillary growth were associated with extensive spread through alveolar spaces, high proliferation, higher stage, low rates of EGFR mutations, and smoking, whereas type 1 papillary tumors showed the opposite associations. The subclassification of papillary growth revealed type-specific associations for overall and disease-free survival (disease-free survival type 1: 67.1 mo, type 2: 56.8 mo, type 3: 49.9 mo, P = 0.025). The presence of any papillary type 3 pattern was a predominant pattern independent predictor of worse overall survival (hazard ratio = 2.5, P = 0.02). For a future grading system of lung ADC, categorization of papillary growth in 1 single category might not be adequate, as this pattern contains a heterogenous mix of tumors with a divergent prognosis. We suggest that papillary pattern types should be separated to further improve the prognostic power of ADC growth pattern analysis.