Cribriform and fused glands are patterns of high-grade pulmonary adenocarcinoma
Cribriform and fused glands are patterns of high-grade pulmonary adenocarcinoma
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DOI：
10.1016/j.humpath.2013.10.011
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发表时间：
2014-02-01
期刊：
影响因子：
3.3
通讯作者：
Rekhtman, Natasha
中科院分区：
文献类型：
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作者：
Moreira, Andre L.;Joubert, Philippe;Rekhtman, Natasha
2011年国际肺癌研究协会、美国胸科学会和欧洲呼吸学会对肺腺癌的分类承认了不同组织学模式对预后的重要性，但没有解决肿瘤分级的问题。我们以前开发了一种肺腺癌的客观和预后分级系统，该系统基于肺腺癌转移潜能的关联模式。最好的预后分层是通过将两种最主要的模式(组织学评分)的分级相加来实现的。在这里，我们通过评估不同类型腺癌的预后重要性来扩展这项工作，这些类型没有得到新的国际肺癌研究协会/美国胸科协会/欧洲呼吸协会分类的承认。本文对249例I期腺癌的病理标本进行了复习。记录每个病例的标准型和非标准型(筛状腺和融合腺)的比例。评估标准和非标准模式的存在、肿瘤组织学评分和无病生存期之间的关系。筛状腺和融合腺分别占肿瘤的15%和29%。这些非标准模式分别占整个肿瘤的10%到100%，但分别只有5%和7%的肿瘤是主要模式。腺体形态复杂的存在与实体形态(P<；.001)和高组织学评分(P<；.0001)相关。以复杂腺样为主的肿瘤的无瘤生存率与高级别肿瘤相似(P=.932)，但明显低于低级别和中等级别肿瘤(P=.0025)。复杂的腺体类型具有显著的预后价值，应被认为是高级别腺癌的类型。(C)2014 Elsevier Inc.保留所有权利。
The 2011 International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society classification of pulmonary adenocarcinoma recognizes the prognostic significance of different histologic patterns but does not address the issue of tumor grade. We previously developed an objective and prognostic grading system for pulmonary adenocarcinomas that is based on associating patterns with their metastatic potential. The best prognostic stratification was achieved by summing the grades of the 2 most predominant patterns (histologic score). Here, we extend this work by evaluating the prognostic importance of variant patterns of adenocarcinoma, which are not recognized by the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Pathologic specimens from 249 resected stage I adenocarcinomas were reviewed. The proportions of standard and nonstandard patterns (cribriform and fused glands) were recorded for each case. The associations between the presence of standard and nonstandard patterns, tumor histologic score, and disease-free survival were evaluated. Cribriform and fused gland patterns were observed in 15% and 29% of tumors, respectively. These nonstandard patterns each composed 10% to 100% of the entire tumors but were the predominant pattern in only 5% and 7% of tumors, respectively. The presence of complex glandular patterns was associated with solid pattern (P < .001) and high histologic score (P < .0001). Disease-free survival for tumors with predominant complex glandular patterns was similar to that for high-grade tumors (P = .932) and was significantly worse than that for low- and intermediate-grade tumors (P = .0025). Complex glandular patterns have a significant prognostic value and should be considered patterns of high-grade adenocarcinoma. (C) 2014 Elsevier Inc. All rights reserved.