最新国际肺腺癌分类方法回顾性分析具有细支气管肺泡癌特征的肺腺癌209例

田璇; 孙蕾娜; 王静; 董元焕; 战忠利

doi:10.3969/j.issn.1000-8179.2013.08.011

Retrospective review of 209 lung adenocarcinoma patients with bronchioloalveolar carcinoma using the new international IASLC/ ATS/ERS classification for lung adenocarcinoma

Xuan TIAN^①,
Lei na SUN^①,
Jing WANG^①,
Yuan huan DONG^②,
Zhong li ZHAN^{①
, ,}

①.
Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Treatment of Tianjin City, Tianjin Diagnosis and Therapy Center of Lung Cancer, Tianjin 300060, China
②.
Department of Pathology, Ninghe County Hospital, Tianjin 301500, China

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Corresponding author: Zhongli ZHAN; E-mail: goonwj123@sina.com

摘要

摘要: 目的探讨最新国际肺腺癌分类中肺腺癌各组织学亚型与预后的相关性。方法收集天津医科大学附属肿瘤医院2000年1月至2005年12月间经手术切除、病理诊断为细支气管肺泡癌(bronchioloalveolar carcinoma, BAC)或伴有BAC成分的腺癌209例。按照肺癌新分类, 对所有病例组织学切片进行复习和分类, 同时进行临床资料的收集和随访。结果原诊断BAC的209例病例中原位腺癌(adenocarcinoma in situ, AIS)20例, 微小浸润性腺癌(minimally invasive adenocarcinoma, MIA)13例, 鳞屑样生长方式为主型腺癌(Lepidic predominant adenocarcinoma, LPA)82例, 乳头状和腺泡状为主型55例, 实性型和微乳头为主型39例。随访发现, 腺癌的组织学亚型与5年生存率有显著的相关性, AIS和MIA两组患者的5年生存率均为100%, 且均无淋巴结转移; LPA患者5年生存率为54.5%;腺泡型和乳头型腺癌的患者比AIS、MIA、LPA三组预后差, 而实性型和微乳头型的病例预后最差。结论肺腺癌中AIS和MIA有独特的临床病理特征及较好的预后。对具有细支气管肺泡癌特征的肺腺癌, 严格按照最新国际肺腺癌分类标准进行亚型分型, 对指导临床治疗及预测预后有重要意义。
- 原位腺癌 /
- 微小浸润性腺癌 /
- 细支气管肺泡癌 /
- 预后
Abstract: Objective This work aims to investigate the correlation of the prognosis of lung adenocarcinoma(LAC) patients with their histologic subtype based on the new international classifications for lung adenocarcinoma. Methods Data of 209 patients with bronchioloalveolar carcinoma(BAC) or adenocarcinoma patients with the BAC feature who underwent surgery in the Tianjin Medical University Cancer Institute and Hospital between January 2000 and December 2005 were reviewed.The clinicopathologic characteristics and prognosis of LAC were analyzed retrospectively. Results Based on the new diagnostic criteria for LAC classification(published in 2011), the 209 LAC cases were classified into five groups: a, 20 adenocarcinomas in situ(AIS, nonmucinous); b, 13 minimally invasive adenocarcinomas(MIA); c, 82 adenocarcinomas with a prominent lepidic growth pattern(LPAs); d, 55 cases with predominant acinar and papillary adenocarcinoma, and 39 with predominant micropapillary adenocarcinomas and solid adenocarcinoma with mucin.The new LAC classification is correlated with the 5-year survival rate.AIS and MIA have more indolent clinical courses. Conclusion AIS and MIA have distinct clinicopathologic characteristics and better prognosis.Therefore, successful diagnosis of the pulmonary adenocarcinoma with the features of BAC is critical for guiding clinical treatment and establishing a prognosis.
- adenocarcinoma in situ /
- minimally invasive adenocarcinoma /
- bronchioloalveolar carcinoma /
- prognosis

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图 1 肺腺癌亚型组织学特点

Figure 1. Histologic classification of lung adenocarcinoma

A: Adenocarcinoma in situ, non-mucinous(H & E×200);B: Adenocarcino-ma in situ, mucinous(H & E×40);C: Micropapillary adenocarcinoma(H & E×100);D: Irregular angulated glands in a fibrous stroma within aninvasive focus(H & E×200);E: Papillary adenocarcinoma(H & E×200);F: Acinar adenocarcinoma(H & E×100)

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图 2 肺腺癌各亚型的无瘤生存时间比较

Figure 2. Comparison of the tumor-free survival with the predominant histologic subtype

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表 1 相关临床病理参数对肺癌患者5年生存率的影响

Table 1. Effects of the clinicopathologic parameters on the 5-year survival rate of lung cancer patients

表 2 肺腺癌各组织学亚型5年生存率的比较

Table 2. Comparison of the 5-year survival rates of lung adenocarcinoma patients with various histologic subtypes

参考文献(15)

[1]	Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcino ma subtype predict patient survival?: A clinicopathologic studybased on the new international association for the study of lung can cer/American thoracic society/European respiratory society interna tional multidisciplinary lung adenocarcinoma classification[J]. J Tho rac Oncol, 2011, 6(9): 1496-1504. doi: 10.1097/JTO.0b013e318221f701
[2]	Kim HK, Choi YS, Kim J, et al. Management of multiple pureground-glass opacity lesions in patients with bronchioloalveolarcarcinoma[J]. J Thorac Oncol, 2010, 5(2): 206-210. doi: 10.1097/JTO.0b013e3181c422be
[3]	Lin DM, Ma Y, Zheng S, et al. Prognostic value of bronchioloalve olar carcinoma component in lung adenocarcinoma[J]. Histol Histo pathol, 2006, 21(6): 627-632.
[4]	Travis WD, Brambilla E, Noguchi M, et al. International associa tion for the study of lung cancer/American thoracic society/Europe an respiratory society international multidisciplinary classificationof lung adenocarcinoma[J]. J Thorac Oncol, 2011, 6(2): 244—285.
[5]	Maeshima AM, Tochigi N, Yoshida A, et al. Histological scoringfor small lung adenocarcinomas 2 cm or Less in diameter: a reliableprognostic indicator[J]. J Thorac Oncol, 2010, 5(3): 333-339. doi: 10.1097/JTO.0b013e3181c8cb95
[6]	Xu, L, Tavora F, Battafarano R, et al. Adenocarcinomas withprominent lepidic spread: retrospective review applying new classifi cation of the American thoracic society[J]. Am J Surg Pathol, 2012, 36(2): 273-282. doi: 10.1097/PAS.0b013e31823b3eeb
[7]	Hamaji M, Allen MS, Cassivi SD, et al. Surgical treatment of meta chronous second primary lung cancer after complete resection ofnon-small cell lung cancer[J]. J Thorac Cardiovasc Surg, 2013, 145(3): 683-690. doi: 10.1016/j.jtcvs.2012.12.051
[8]	Casali C, Rossi G, Marchioni A, et al. A single institution-basedretrospective study of surgically treated bronchioloalveolar adeno carcinoma of the lung: clinicopathologic analysis, molecular fea tures, and possible pitfalls in routine practice[J]. J Thorac Oncol, 2010, 5(6): 830-836. doi: 10.1097/JTO.0b013e3181d60ff5
[9]	Fukui T, Sakakura N, Mori S, et al. Controversy about small pe ripheral lung adenocarcinomas: how should we manage them[J]. JThorac Oncol, 2007, 2(6): 546-552. doi: 10.1097/JTO.0b013e318060d30d
[10]	Rusch VW, Asamura H, Watanabe H, et al. The IASLC lung can cer staging project: a proposal for a new international lymph nodemap in the forthcoming seventh edition of the TNM classificationfor lung cancer[J]. J Thorac Oncol, 2009, 4(5): 568-577. doi: 10.1097/JTO.0b013e3181a0d82e
[11]	Borczuk AC, Qian F, Kazeros A, et al. Invasive size is an indepen dent predictor of survival in pulmonary adenocarcinoma[J]. Am JSurg Pathol, 2009, 33(3): 462-469. doi: 10.1097/PAS.0b013e318190157c
[12]	Yoshizawa A, Motoi N, Riely GJ, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic sub groups and implications for further revision of staging based onanalysis of 514 stage I cases[J]. Mod Pathol, 2011, 24(5): 653-664. doi: 10.1038/modpathol.2010.232
[13]	Haruki T, Shomori K, Shiomi T, et al. The morphological diversityof small lung adenocarcinoma with mixed subtypes is associatedwith local invasiveness and prognosis[J]. Eur J Cardiothorac Surg, 2011, 39(5): 763-768. doi: 10.1016/j.ejcts.2010.07.047
[14]	Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcino ma of the lung: histologic characteristics and prognosis[J]. Cancer, 1995, 75(12): 2844-2852. doi: 10.1002/1097-0142(19950615)75:12<2844::AID-CNCR2820751209>3.0.CO;2-#
[15]	Sakurai H, Maeshima A, Watanabe S, et al. Grade of stromal inva sion in small adenocarcinoma of the lung: histopathological mini mal invasion and prognosis[J]. Am J Surg Pathol, 2004, 28(2): 198-206. doi: 10.1097/00000478-200402000-00007