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Prognostic significance of histologic subtype in pStage I lung adenocarcinoma. Med Oncol 2017; 34:100. [PMID: 28432617 DOI: 10.1007/s12032-017-0962-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/12/2017] [Indexed: 01/15/2023]
Abstract
The International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS) proposed a new histologic classification of lung adenocarcinoma in 2011. While several studies have already validated the prognostic value of this new classification of lung adenocarcinoma, we conducted own investigation in the present study. This study included 197 patients with invasive lung adenocarcinoma who underwent complete resection. Pathologic diagnoses were made in accordance with the new IASLC/ATS/ERS classification for lung adenocarcinoma. The lepidic/acinar/papillary group had a significantly better prognosis than the micropapillary/solid/invasive mucinous adenocarcinoma group (5-year recurrence-free survival [RFS] 73 vs. 21%: p < 0.01, 5-year overall survival 85 vs. 52%: p < 0.01). Age (hazard ratio [HR], 1.898; p = 0.03), CEA (HR, 1.873; p = 0.03), pStage (HR, 6.149; p < 0.01), and histologic subtype (HR, 2.342; p = 0.01) were independent prognostic factors for the RFS. Furthermore, age (HR, 3.242; p = 0.04), CEA (HR, 3.405; p = 0.03) and histologic subtype (HR, 11.108; p < 0.01) were independent prognostic factors for the progression-free survival in pStage I. The histologic subtype correlated with the prognosis of pStage I of lung adenocarcinoma. Patients in the high-grade group of lung adenocarcinoma, which included solid, micropapillary and invasive mucinous adenocarcinoma with pStage I, should be considered candidates for postoperative adjuvant therapy.
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Herfs M, Longuespée R, Quick CM, Roncarati P, Suarez-Carmona M, Hubert P, Lebeau A, Bruyere D, Mazzucchelli G, Smargiasso N, Baiwir D, Lai K, Dunn A, Obregon F, Yang EJ, Pauw ED, Crum CP, Delvenne P. Proteomic signatures reveal a dualistic and clinically relevant classification of anal canal carcinoma. J Pathol 2017; 241:522-533. [DOI: 10.1002/path.4858] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Michael Herfs
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
| | - Rémi Longuespée
- Mass Spectrometry Laboratory, Systems Biology and Chemical Biology, GIGA-Research; University of Liège; Liège Belgium
| | - Charles M Quick
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Patrick Roncarati
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
| | - Meggy Suarez-Carmona
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
| | - Pascale Hubert
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
| | - Alizée Lebeau
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
| | - Diane Bruyere
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
| | - Gabriel Mazzucchelli
- Mass Spectrometry Laboratory, Systems Biology and Chemical Biology, GIGA-Research; University of Liège; Liège Belgium
| | - Nicolas Smargiasso
- Mass Spectrometry Laboratory, Systems Biology and Chemical Biology, GIGA-Research; University of Liège; Liège Belgium
| | - Dominique Baiwir
- Mass Spectrometry Laboratory, Systems Biology and Chemical Biology, GIGA-Research; University of Liège; Liège Belgium
- GIGA Proteomic Facility; University of Liège; Liège Belgium
| | - Keith Lai
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Andrew Dunn
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Fabiola Obregon
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Eric J Yang
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Edwin De Pauw
- Mass Spectrometry Laboratory, Systems Biology and Chemical Biology, GIGA-Research; University of Liège; Liège Belgium
| | - Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Philippe Delvenne
- Laboratory of Experimental Pathology, GIGA-Cancer; University of Liège; Liège Belgium
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Huang D, He X, Zou J, Guo P, Jiang S, Lv N, Alekseyev Y, Luo L, Luo Z. Negative regulation of Bmi-1 by AMPK and implication in cancer progression. Oncotarget 2017; 7:6188-200. [PMID: 26717043 PMCID: PMC4868749 DOI: 10.18632/oncotarget.6748] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/15/2015] [Indexed: 12/31/2022] Open
Abstract
Bmi-1 is a transcriptional regulator that promotes tumor cell self-renewal and epithelial to mesenchymal transition and its upregulation is associated with tumor progression, AMPK is an intracellular fuel-sensing enzyme and plays important roles in tumor cell growth and progression. Thus, the present study aims to examine the regulation of Bmi-1 by AMPK. First, our data revealed that, as compared to adjacent normal tissue, Bmi-1 was highly expressed in gastric cancer, whereas phosphorylation of AMPK (p-AMPK) was reduced. Similar findings were observed in lung adenocarcinomas and appeared that the expression of Bmi-1 was correlated with pathological grades of the cancer, where opposite changes were found in p-AMPK. Second, Metformin, a pharmacological AMPK activator and anti-diabetic drug, or ectopic expression of LKB1, diminished expression of Bmi-1 in cancer cells, an event that was reversed by silencing LKB1. Third, knockdown of LITAF, previously identified as a downstream target of AMPK, upregulated Bmi-1, associated with increased cell viability, colony formation, and migration of cancer cells in vitro. Fourth, metformin increased the abundance of miR-15a, miR-128, miR-192, and miR-194, which was prevented by knockdown of LITAF. Accordingly, transfection of these individual miRNAs downregulated Bmi-1. Altogether, our data for the first time suggest a regulatory axis in cancer cells: AMPK upregulates LITAF, which in turn increases miRNAs, leading to attenuation of Bmi-1 expression.
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Affiliation(s)
- Deqiang Huang
- Research Institute of Digestive Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoling He
- Graduate Program, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China.,Institute of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Junrong Zou
- Graduate Program, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China.,Institute of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Pei Guo
- Graduate Program, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China.,Institute of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Shanshan Jiang
- Graduate Program, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China.,Institute of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Nonghua Lv
- Research Institute of Digestive Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuriy Alekseyev
- Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Lingyu Luo
- Research Institute of Digestive Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhijun Luo
- Institute of Basic Medical Sciences, Nanchang University, Nanchang, Jiangxi, P.R. China.,Department of Biochemistry, Boston University School of Medicine, Boston, MA 02118, USA
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Wang X, Schoenhals JE, Li A, Valdecanas DR, Ye H, Zang F, Tang C, Tang M, Liu CG, Liu X, Krishnan S, Allison JP, Sharma P, Hwu P, Komaki R, Overwijk WW, Gomez DR, Chang JY, Hahn SM, Cortez MA, Welsh JW. Suppression of Type I IFN Signaling in Tumors Mediates Resistance to Anti-PD-1 Treatment That Can Be Overcome by Radiotherapy. Cancer Res 2016; 77:839-850. [PMID: 27821490 DOI: 10.1158/0008-5472.can-15-3142] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 10/04/2016] [Accepted: 10/22/2016] [Indexed: 12/25/2022]
Abstract
Immune checkpoint therapies exhibit impressive efficacy in some patients with melanoma or lung cancer, but the lack of response in most cases presses the question of how general efficacy can be improved. In addressing this question, we generated a preclinical tumor model to study anti-PD-1 resistance by in vivo passaging of Kras-mutated, p53-deficient murine lung cancer cells (p53R172HΔg/+K-rasLA1/+ ) in a syngeneic host exposed to repetitive dosing with anti-mouse PD-1 antibodies. PD-L1 (CD274) expression did not differ between the resistant and parental tumor cells. However, the expression of important molecules in the antigen presentation pathway, including MHC class I and II, as well as β2-microglobulin, were significantly downregulated in the anti-PD-1-resistant tumors compared with parental tumors. Resistant tumors also contained fewer CD8+ (CD8α) and CD4+ tumor-infiltrating lymphocytes and reduced production of IFNγ. Localized radiotherapy induced IFNβ production, thereby elevating MHC class I expression on both parental and resistant tumor cells and restoring the responsiveness of resistant tumors to anti-PD-1 therapy. Conversely, blockade of type I IFN signaling abolished the effect of radiosensitization in this setting. Collectively, these results identify a mechanism of PD-1 resistance and demonstrate that adjuvant radiotherapy can overcome resistance. These findings have immediate clinical implications for extending the efficacy of anti-PD-1 immune checkpoint therapy in patients. Cancer Res; 77(4); 839-50. ©2016 AACR.
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Affiliation(s)
- Xiaohong Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan E Schoenhals
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ailin Li
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Valdecanas
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Huiping Ye
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Baiyun Hospital of Guiyang Medical University, Guiyang Medical University, Guiyang, China
| | - Fenglin Zang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ming Tang
- Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chang-Gong Liu
- Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiuping Liu
- Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sunil Krishnan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James P Allison
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Padmanee Sharma
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick Hwu
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Willem W Overwijk
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen M Hahn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria Angelica Cortez
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Luo X, Zang X, Yang L, Huang J, Liang F, Rodriguez-Canales J, Wistuba II, Gazdar A, Xie Y, Xiao G. Comprehensive Computational Pathological Image Analysis Predicts Lung Cancer Prognosis. J Thorac Oncol 2016; 12:501-509. [PMID: 27826035 DOI: 10.1016/j.jtho.2016.10.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Pathological examination of histopathological slides is a routine clinical procedure for lung cancer diagnosis and prognosis. Although the classification of lung cancer has been updated to become more specific, only a small subset of the total morphological features are taken into consideration. The vast majority of the detailed morphological features of tumor tissues, particularly tumor cells' surrounding microenvironment, are not fully analyzed. The heterogeneity of tumor cells and close interactions between tumor cells and their microenvironments are closely related to tumor development and progression. The goal of this study is to develop morphological feature-based prediction models for the prognosis of patients with lung cancer. METHOD We developed objective and quantitative computational approaches to analyze the morphological features of pathological images for patients with NSCLC. Tissue pathological images were analyzed for 523 patients with adenocarcinoma (ADC) and 511 patients with squamous cell carcinoma (SCC) from The Cancer Genome Atlas lung cancer cohorts. The features extracted from the pathological images were used to develop statistical models that predict patients' survival outcomes in ADC and SCC, respectively. RESULTS We extracted 943 morphological features from pathological images of hematoxylin and eosin-stained tissue and identified morphological features that are significantly associated with prognosis in ADC and SCC, respectively. Statistical models based on these extracted features stratified NSCLC patients into high-risk and low-risk groups. The models were developed from training sets and validated in independent testing sets: a predicted high-risk group versus a predicted low-risk group (for patients with ADC: hazard ratio = 2.34, 95% confidence interval: 1.12-4.91, p = 0.024; for patients with SCC: hazard ratio = 2.22, 95% confidence interval: 1.15-4.27, p = 0.017) after adjustment for age, sex, smoking status, and pathologic tumor stage. CONCLUSIONS The results suggest that the quantitative morphological features of tumor pathological images predict prognosis in patients with lung cancer.
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Affiliation(s)
- Xin Luo
- Department of Bioinformatics, University of Texas Southwestern Medical Center at Dallas, Texas
| | - Xiao Zang
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Texas
| | - Lin Yang
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Texas; Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junzhou Huang
- Department of Computer Sciences and Engineering, University of Texas at Arlington, Arlington, Texas
| | - Faming Liang
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jaime Rodriguez-Canales
- Department of Translational Molecular Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Adi Gazdar
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; Hamon Center for Therapeutic Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Yang Xie
- Department of Bioinformatics, University of Texas Southwestern Medical Center at Dallas, Texas; Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Texas
| | - Guanghua Xiao
- Department of Bioinformatics, University of Texas Southwestern Medical Center at Dallas, Texas; Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Texas.
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Role of CT and PET Imaging in Predicting Tumor Recurrence and Survival in Patients with Lung Adenocarcinoma: A Comparison with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma. J Thorac Oncol 2016; 10:1785-94. [PMID: 26473646 DOI: 10.1097/jto.0000000000000689] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recently, a new lung adenocarcinoma classification scheme was published. The prognostic value of this new classification has not been elaborated together with the value of imaging biomarkers including computed tomography (CT) and positron emission tomography (PET). METHODS We reviewed pathologic specimens and imaging characteristics of primary tumors from 723 consecutive patients who underwent surgical resection for lung adenocarcinoma. On pathology, the predominant histologic subtype and pattern group were quantified. Tumor-shadow disappearance ratio (TDR) on CT and maximum standardized uptake value (SUVmax) on PET were assessed. The relationships between those variables and survival (overall survival [OS] and disease-free survival) were analyzed by using Kaplan-Meier curves and Cox regression analyses. RESULTS The median follow-up period was 3.8 years. There were 137 patients (19%) with recurrence and 167 patients (23%) with metastasis after surgical resection. Among 723 patients, 35 patients (4.8%) had adenocarcinoma in situ, 34 patients (4.7%) had minimally invasive adenocarcinoma, 125 patients (17.3%) had lepidic predominant, 314 patients (43.4%) had acinar predominant, 65 patients (9.0%) had papillary predominant, 23 patients (3.2%) had micropapillary predominant, 113 patients (15.6%) had solid predominant, and 14 patients (1.9%) had variant adenocarcinomas. OS and disease-free survival rates were significantly different according to TDR on CT and SUVmax on PET, predominant subtypes, and pattern groups. On multivariate analysis, the SUVmax (p < 0.001), TDR (p = 0.038), and pattern group (p = 0.015) were independent predictors of OS. CONCLUSIONS TDR on CT, SUVmax on PET, and the new histologic classification schemes appear to be promising parameters for the prognostic stratification of patients with lung adenocarcinomas, allowing for the triage of patients who necessitate further staging workup and adjuvant therapy.
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Lee G, Choi ER, Lee HY, Jeong JY, Ahn JH, Kim S, Bae J, Kim HK, Choi YS, Kim J, Zo J, Lee KS, Shim YM. Pathologic heterogeneity of lung adenocarcinomas: A novel pathologic index predicts survival. Oncotarget 2016; 7:70353-70363. [PMID: 27612421 PMCID: PMC5342557 DOI: 10.18632/oncotarget.11857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/24/2016] [Indexed: 01/15/2023] Open
Abstract
Although the most predominant subtype of invasive lung adenocarcinoma has been reported to have clinical significance, a major limitation of this concept is that most tumors are mixed-subtype. Therefore, we aimed to determine the individual prognostic significance of each subtype and also attempted to establish a pathologic index that reflects the pathologic subtypes and overall heterogeneity of lung adenocarcinomas and evaluated its prognostic significance. The individual prognostic impact of each subtype was assessed from the development cohort using the disease-free survival (DFS) curve of a previous large-scale study. Hazard ratios (HRs) from the development cohort were 1, 1.025, 1.059, 1.495, and 1.160 for the lepidic, acinar, papillary, micropapillary, and solid pattern subtype, respectively. Based on the calculated HR of each subtype, four indices representing pathologic heterogeneity were developed. The first and second indices were defined as the sum of the proportions of each subtype multiplied by their HRs, with the addition of either entropy or Gini coefficient, respectively. The third index was calculated as the sum of all subtype percentages multiplied by their HRs. To emphasize heterogeneity, the fourth index was defined as the simple arithmetic sum of the scores of the subtypes multiplied by their HRs. Each subtype was assigned a score of 0 if the subtype was absent and a score of 1 if the subtype was present in a binary fashion. We applied these four pathologic indices to a validation group of 148 patients with comprehensive histologic subtyping for completely resected lung adenocarcinomas. DFS curves were plotted and predictive ability of each pathologic index was evaluated. Among the four pathologic indices, only pathologic index 3 enabled significant patient stratification in the validation cohort according to DFS (P = 0.004) and showed the highest Harrell's C index of 0.691 of all four pathologic indices. In conclusion, we estimated the HR of each subtype and generated four pathologic indices that reflect heterogeneity. One of these, index 3, the pathologic heterogeneity index based on the sum of all subtype percentages multiplied by their HR, possesses good prognostic ability for predicting survival in patients with lung adenocarcinoma.
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Affiliation(s)
- Geewon Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - E-Ryung Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yun Jeong
- Department of Pathology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joong Hyun Ahn
- Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea
| | - Seonwoo Kim
- Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea
| | - Jungmin Bae
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeil Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chirieac LR. Tumor cell proliferation, proliferative index and mitotic count in lung cancer. Transl Lung Cancer Res 2016; 5:554-556. [PMID: 27827463 DOI: 10.21037/tlcr.2016.10.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lung Adenocarcinoma Staging Using the 2011 IASLC/ATS/ERS Classification: A Pooled Analysis of Adenocarcinoma In Situ and Minimally Invasive Adenocarcinoma. Clin Lung Cancer 2016; 17:e57-e64. [DOI: 10.1016/j.cllc.2016.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/20/2022]
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Huynh TG, Morales-Oyarvide V, Campo MJ, Gainor JF, Bozkurtlar E, Uruga H, Zhao L, Gomez-Caraballo M, Hata AN, Mark EJ, Lanuti M, Engelman JA, Mino-Kenudson M. Programmed Cell Death Ligand 1 Expression in Resected Lung Adenocarcinomas: Association with Immune Microenvironment. J Thorac Oncol 2016; 11:1869-1878. [PMID: 27568346 DOI: 10.1016/j.jtho.2016.08.134] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/18/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Programmed cell death ligand 1 (PD-L1) expression on tumor cells can be upregulated via activation of CD8+ cytotoxic T lymphocytes (CTLs) or the T helper cell (Th1) pathway, counterbalancing the CTL/Th1 microenvironment. However, PD-L1 expression in association with subtypes of tumor-associated lymphocytes and molecular alterations has not been well characterized in lung adenocarcinomas. METHODS PD-L1 expression was evaluated in 261 resected lung adenocarcinomas using tissue microarrays and various scoring systems, and was correlated with clinicopathologic/molecular features, including the extent/subtype of tumor-associated lymphocytes (i.e., CD8, T-bet [Th1 transcription factor], and GATA3 [Th2 transcription factor]), and patient outcomes. RESULTS PD-L1 expression was present in 129 (49%), 95 (36.5%), and 62 (24%) cases using cutoffs of ≥1%, ≥5%, and ≥50%, respectively, 98 (38%) by H score and 72 (28%) by immune score. PD-L1 expression was associated with abundant CD8+ and/or T-bet+ tumor-infiltrating lymphocytes and EGFR wild-type, significant smoking history, and aggressive pathologic features. In addition, concurrent PD-L1 expression and abundant CD8+ tumor-associated lymphocytes were seen in 25% of KRAS mutants or cases with no alterations by clinical molecular testing as opposed to only 7.4% of EGFR mutants. PD-L1 expression was significantly associated with decreased progression-free and overall survival rates by univariate analysis, but not by multivariate analysis. CONCLUSION PD-L1 expression in resected lung adenocarcinomas is frequently observed in the presence of CTL/Th1 microenvironment, in particular in those with KRAS mutations or no common molecular alterations, suggesting that blockade of the PD-1/PD-L1 axis may be a promising treatment strategy to reinstitute active immune response for at least a subset of such patient populations.
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Affiliation(s)
- Tiffany G Huynh
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vicente Morales-Oyarvide
- Department of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Meghan J Campo
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Justin F Gainor
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Emine Bozkurtlar
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hironori Uruga
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ling Zhao
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Aaron N Hata
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Eugene J Mark
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Engelman
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts.
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The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2016; 10:1243-1260. [PMID: 26291008 DOI: 10.1097/jto.0000000000000630] [Citation(s) in RCA: 2852] [Impact Index Per Article: 356.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and
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Kadota K, Miyai Y, Katsuki N, Kushida Y, Matsunaga T, Okuda M, Yokomise H, Kanaji N, Bandoh S, Haba R. Nuclear grade based on transbronchial cytology is an independent prognostic factor in patients with advanced, unresectable non-small cell lung cancer. Cancer Cytopathol 2016; 124:630-40. [DOI: 10.1002/cncy.21736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/29/2016] [Accepted: 04/19/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Kyuichi Kadota
- Department of Diagnostic Pathology, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Yumi Miyai
- Department of Diagnostic Pathology, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Naomi Katsuki
- Department of Diagnostic Pathology, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Yoshio Kushida
- Department of Diagnostic Pathology, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Toru Matsunaga
- Department of Diagnostic Pathology, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Masaya Okuda
- Department of General Thoracic Surgery, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Hiroyasu Yokomise
- Department of General Thoracic Surgery, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Nobuhiro Kanaji
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Shuji Bandoh
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine; Kagawa University; Kagawa Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of Medicine; Kagawa University; Kagawa Japan
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Zhao Y, Shen H, Qiu C, Zhang T, Hu P, Qu X, Liu Q, Du J. Invasion Types Are Associated With Poor Prognosis in Lung Squamous Carcinoma Patients. Medicine (Baltimore) 2015; 94:e1634. [PMID: 26512557 PMCID: PMC4985371 DOI: 10.1097/md.0000000000001634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although the prognostic significance of the histologic patterns in lung adenocarcinoma is being identified, no significant prognostic indicators in lung squamous carcinoma are accepted as a standard universally. The aim of this study was to evaluate the histologic characteristics incorporating the defined invasion types and distinguish the features that can reflect prognosis.We reviewed all slices of 132 patients with lung squamous carcinoma. The cases were classified according to the World Health Organization (WHO) classification and were evaluated for tumor budding, single cell invasion, large cell invasion, cytologic atypia degree, mitotic count, number of buds, tumor nest size, fibrosis, and necrosis.In univariate analysis, overall survival was associated significantly with age (P = 0.023), lymph nodes metastasis (P < 0.001), distant organ metastasis (P < 0.001), pleural invasion (P < 0.001), tumor budding (P = 0.003), single cell invasion (P = 0.001), mitotic count (P < 0.001), and the cytologic atypia degree (P = 0.009). However, the subtypes of 2004 WHO classification showed no association with outcome (P = 0.209). In multivariate analysis, the independent significant prognostic indicators of lung squamous carcinoma were tumor budding (hazard ratio [HR] = 0.466, P = 0.005), single cell invasion (HR = 0.447, P = 0.003), mitotic count (HR = 0.502, P = 0.048) and cytologic atypia degree (HR = 0.479, P = 0.024).Lung squamous carcinomas with the invasion types were associated with a poor prognosis.
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Affiliation(s)
- Yang Zhao
- From the Institute of Oncology (YZ, CQ, TZ, PH, XQ, QL, JD), Shandong Provincial Hospital Affiliated to Shandong University, Shandong University; Department of Thoracic Surgery (JD), Shandong Provincial Hospital Affiliated to Shandong University, Shandong University; and Department of Oncology (HS), Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, PR China
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Clinical impact of minimal micropapillary pattern in invasive lung adenocarcinoma: prognostic significance and survival outcomes. Am J Surg Pathol 2015; 39:660-6. [PMID: 25724001 DOI: 10.1097/pas.0000000000000399] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Micropapillary subtype has recently been established to be a distinct marker for poor prognosis in lung adenocarcinomas. According to the current classification of lung adenocarcinomas, all subtypes are listed semiquantitatively in 5% increments. In other words, a minimal amount of the micropapillary pattern, precisely <5% of the entire tumor is disregarded. Therefore, we sought to assess the prognostic significance and survival outcomes in patients with a micropapillary pattern proportion of <5% of the entire tumor. A total of 525 patients with lung adenocarcinoma were classified into 3 subgroups according to the presence and proportion of micropapillary subtype: (1) ≥5% of the micropapillary pattern (n=114); (2) <5% of the micropapillary pattern (n=115); and (3) absence (<1%) of the micropapillary pattern (n=296). Sex, TNM stage, lymph node status (N status), tumor size, and predominant subtype demonstrated a significant difference among the 3 subgroups. Overall survival (OS) and disease-free survival (DFS) were significantly different among the 3 subgroups (P=0.009 and 0.001 for OS and DFS, respectively). Furthermore, OS was significantly better in patients without the micropapillary pattern (<1%) than in those with <5% (P=0.034). At multivariate analyses, age (P=0.005) and N status (P=0.005) were independent prognostic factors influencing OS. In conclusion, our results demonstrated that even a small proportion of the micropapillary pattern, specifically <5% of the entire tumor has a significant prognostic impact on OS. N status remained an independent prognostic factor that negatively influenced OS.
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Comprehensive pathological analyses in lung squamous cell carcinoma: single cell invasion, nuclear diameter, and tumor budding are independent prognostic factors for worse outcomes. J Thorac Oncol 2015; 9:1126-39. [PMID: 24942260 DOI: 10.1097/jto.0000000000000253] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION For lung squamous cell carcinomas, there are no pathological findings that have been universally accepted as prognostic factors, with the exception of pathological stage. Tumor budding and nuclear grade have been recognized as a poor prognostic factor in other carcinomas. In this study, we investigated whether pathological findings could determine prognosis in lung squamous cell carcinomas. METHODS All available tumor slides from patients with surgically resected, solitary lung squamous cell carcinomas (1999-2009) were reviewed (n = 485; stage I/II/III, 281/136/68). Tumors were evaluated for differentiation, subtypes (keratinizing, nonkeratinizing, basaloid pattern, papillary growth, and clear cell feature), tumor nest size (tumor budding and single cell invasion), and nuclear grade (nuclear diameter and mitosis). Overall survival (OS) was estimated using the Kaplan-Meier method (stratified by pathological stage), and group differences were investigated using the stratified log-rank test and the Cox proportional hazards model. RESULTS OS was significantly decreased in patients with versus without single cell invasion (p = 0.002 for the entire tumor and p = 0.001 for tumor edge), with large versus small nuclei (p = 0.011), and with high versus low grade tumor budding (p < 0.001 for maximum and p = 0.007 for total). In multivariate analyses, single cell invasion (hazard ratio [HR], 1.47-1.49), nuclear diameter (HR, 1.09-1.33), and tumor budding (HR, 1.04) were independent prognostic factors of OS. However, histologic subtyping including keratinizing, nonkeratinizing, basaloid, and clear cell subtypes did not show prognostic significance. CONCLUSIONS Pathological factors can help stratify prognosis in patients with lung squamous cell carcinomas.
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Yeh YC, Nitadori JI, Kadota K, Yoshizawa A, Rekhtman N, Moreira AL, Sima CS, Rusch VW, Adusumilli PS, Travis WD. Using frozen section to identify histological patterns in stage I lung adenocarcinoma of ≤ 3 cm: accuracy and interobserver agreement. Histopathology 2015; 66:922-38. [PMID: 24889415 DOI: 10.1111/his.12468] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/27/2014] [Indexed: 01/15/2023]
Abstract
AIMS The IASLC/ATS/ERS classification of lung adenocarcinoma provides a prognostically significant histological subclassification. The aim of this study was to investigate the accuracy, limitations and interobserver agreement of frozen sections for predicting histological subtype. METHODS AND RESULTS Frozen section and permanent section slides from 361 resected stage I lung adenocarcinomas ≤ 3 cm in size were reviewed for predominant histological subtype and the presence or absence of lepidic, acinar, papillary, micropapillary and solid patterns. Fifty cases were additionally reviewed by three pathologists to determine interobserver agreement. To test the accuracy of frozen section in judging degree of invasion, five pathologists reviewed frozen section slides from 35 cases with a predominantly lepidic pattern. There was moderate agreement on predominant histological subtype between frozen sections and final diagnosis (κ = 0.565). Frozen sections had high specificity for micropapillary and solid patterns (94% and 96%, respectively), but sensitivity was low (37% and 69%, respectively). The interobserver agreement was satisfactory (κ > 0.6, except for the acinar pattern). CONCLUSIONS Frozen section can provide information on the presence of aggressive histological patterns-micropapillary and solid-with high specificity but low sensitivity. It was difficult to predict the predominant pattern on the basis of frozen sections, mostly because of sampling issues.
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Affiliation(s)
- Yi-Chen Yeh
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jun-ichi Nitadori
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kyuichi Kadota
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Akihiko Yoshizawa
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andre L Moreira
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Camelia S Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Valerie W Rusch
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Center for Cell Engineering, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Ahn T, Lee E, Huh N, Park T. Personalized identification of altered pathways in cancer using accumulated normal tissue data. ACTA ACUST UNITED AC 2015; 30:i422-9. [PMID: 25161229 PMCID: PMC4147902 DOI: 10.1093/bioinformatics/btu449] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
MOTIVATION Identifying altered pathways in an individual is important for understanding disease mechanisms and for the future application of custom therapeutic decisions. Existing pathway analysis techniques are mainly focused on discovering altered pathways between normal and cancer groups and are not suitable for identifying the pathway aberrance that may occur in an individual sample. A simple way to identify individual's pathway aberrance is to compare normal and tumor data from the same individual. However, the matched normal data from the same individual are often unavailable in clinical situation. Therefore, we suggest a new approach for the personalized identification of altered pathways, making special use of accumulated normal data in cases when a patient's matched normal data are unavailable. The philosophy behind our method is to quantify the aberrance of an individual sample's pathway by comparing it with accumulated normal samples. We propose and examine personalized extensions of pathway statistics, overrepresentation analysis and functional class scoring, to generate individualized pathway aberrance score. RESULTS Collected microarray data of normal tissue of lung and colon mucosa are served as reference to investigate a number of cancer individuals of lung adenocarcinoma (LUAD) and colon cancer, respectively. Our method concurrently captures known facts of cancer survival pathways and identifies the pathway aberrances that represent cancer differentiation status and survival. It also provides more improved validation rate of survival-related pathways than when a single cancer sample is interpreted in the context of cancer-only cohort. In addition, our method is useful in classifying unknown samples into cancer or normal groups. Particularly, we identified 'amino acid synthesis and interconversion' pathway is a good indicator of LUAD (Area Under the Curve (AUC) 0.982 at independent validation). Clinical importance of the method is providing pathway interpretation of single cancer, even though its matched normal data are unavailable. AVAILABILITY AND IMPLEMENTATION The method was implemented using the R software, available at our Web site: http://bibs.snu.ac.kr/ipas. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- TaeJin Ahn
- Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea
| | - Eunjin Lee
- Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea
| | - Nam Huh
- Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea
| | - Taesung Park
- Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea Samsung Advanced Institute of Technology, 130, Suwon-si, Gyeonggi-do, 443-803, Korea, Samsung Genome Institute, Seoul, 135-710, Korea, Interdisciplinary Program in Bioinformatics and Department of Statistics, Seoul National University, Seoul, South Korea
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Clinical and pathologic prognostic factors that are influential in the survival and prognosis of lung adenocarcinomas and invasive predominant subtypes. Int Surg 2014; 98:191-9. [PMID: 23971769 DOI: 10.9738/intsurg-d-13-00029.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Therapeutic approaches to lung adenocarcinomas differ because of their heterogeneous morphologies, prognoses, and clinical features. For this reason, new histopathologic classifications for lung adenocarcinomas were done by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society to form subtypes with homogeneous prognoses. There are limited clinical data in the literature on the prognosis of the subgroups formed according to the new classification. A total of 86 patients with adenocarcinoma who had undergone pathologic stages I and II curative resection and mediastinal lymph node dissection were retrospectively analyzed according to the seventh TNM staging system revised by the Union for International Cancer Control/American Joint Committee on Cancer. Histologic subtyping was reassessed according to the dominant histopathologic morphology. When survival rates of lung adenocarcinomas were compared according to their localizations, it was observed that adenocarcinomas localized to the right hemithorax had a longer survival than the ones with left hemithorax localization (P = 0.026). When necrosis was taken into account, it was seen that necrosis rate was higher in solid predominant type compared with other types, whereas it was lower in acinary type (P = 0.046). When peritumoral lymphovascular invasion data were assessed, it was observed that disease-free survival was influenced in a negative fashion (P = 0.018). New histopathologic classification of adenocarcinomas has been a step forward to attaining homogeneous groups, but when the biologic heterogeneity of the adenocarcinomas is taken into account, the authors believe that considering the peritumoral lymphatic vascular invasion, left hemithorax localization, and tumoral necrosis entities in the upcoming TNM classification will contribute to evaluating the prognosis.
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Tang ER, Schreiner AM, Pua BB. Advances in lung adenocarcinoma classification: a summary of the new international multidisciplinary classification system (IASLC/ATS/ERS). J Thorac Dis 2014; 6:S489-501. [PMID: 25349701 DOI: 10.3978/j.issn.2072-1439.2014.09.12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/26/2014] [Indexed: 11/14/2022]
Abstract
Due to advances in the understanding of lung adenocarcinoma since the advent of its 2004 World Health System classification, an international multidisciplinary panel [sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS)] has recently updated the classification system for lung adenocarcinoma, the most common histologic type of lung cancer. Here, we summarize and highlight the new criteria and terminology, certain aspects of its clinical relevance and its potential treatment impact, and future avenues of research related to the new system.
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Affiliation(s)
- Elizabeth R Tang
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Andrew M Schreiner
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Bradley B Pua
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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Lee MC, Kadota K, Buitrago D, Jones DR, Adusumilli PS. Implementing the new IASLC/ATS/ERS classification of lung adenocarcinomas: results from international and Chinese cohorts. J Thorac Dis 2014; 6:S568-80. [PMID: 25349708 DOI: 10.3978/j.issn.2072-1439.2014.09.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/26/2014] [Indexed: 12/13/2022]
Abstract
A new histologic classification of lung adenocarcinoma was proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) in 2011 to provide uniform terminology and diagnostic criteria for multidisciplinary strategic management. This classification proposed a comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary, and solid pattern) and a semi-quantitative assessment of histologic patterns (in 5% increments) in an effort to choose a single, predominant pattern in invasive adenocarcinomas. The prognostic value of this classification has been validated in large, independent cohorts from multiple countries. In patients who underwent curative-intent surgery, those with either an adenocarcinoma in situ (AIS) or a minimal invasive adenocarcinoma have nearly 100% disease-free survival and are designated "low grade tumors". For invasive adenocarcinomas, the acinar and papillary predominant histologic subtypes were usually designated as "intermediate grade" while the solid and micropapillary predominant histologic subtypes were designated "high grade" tumors; this was based on the statistic difference of overall survival. This classification, coupled with additional prognostic factors [nuclear grade, cribriform pattern, high Ki-67 labeling index, thyroid transcription factor-1 (TTF-1) immunohistochemistry, immune markers, and (18)F-fluorodeoxyglucose uptake on positron emission tomography (PET)] that we have published on, could further stratify patients into prognostic subgroups and may prove helpful for individual patient care. With regard to Chinese oncologists, the implementation of this new classification only requires hematoxylin and eosin (H&E) stained slides and basic pathologic training, both of which require no additional costs. More importantly, this new classification system could provide informative data for better selection and stratification of clinical trials and molecular studies.
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Affiliation(s)
- Ming-Ching Lee
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Kyuichi Kadota
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Daniel Buitrago
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - David R Jones
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
| | - Prasad S Adusumilli
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ; 3 Center for Cell Engineering, Sloan Kettering Institute, New York, NY 10065, USA
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Yang F, Chen K, Liao Y, Li X, Sun K, Bao D, Wang J. Risk factors of recurrence for resected T1aN0M0 invasive lung adenocarcinoma: a clinicopathologic study of 177 patients. World J Surg Oncol 2014; 12:285. [PMID: 25216551 PMCID: PMC4168167 DOI: 10.1186/1477-7819-12-285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 09/02/2014] [Indexed: 12/25/2022] Open
Abstract
Background This study aimed at identifying risk factors of recurrence for completely resected pathologic T1aN0M0 lung adenocarcinomas. Methods We reviewed the records of 177 T1aN0M0 invasive adenocarcinoma patients, and re-classified achieved surgical specimens according to the new International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) lung adenocarcinoma classification. Impact on recurrence-free survival (RFS) for age, gender, smoking history, lymphovascular invasion (LVI) and new classification was analyzed by log-rank test and Cox regression. Two existing prognostic grouping schemes of new classification were compared, and subsequently, the correlation of high-grade group in the better prognostic grouping model with clinical data was investigated statistically. Results The 5-year recurrence-free rate was 83.7%. The LVI and new adenocarcinoma classification were significantly associated with 5-year RFS (P = 0.012; P = 0.022, respectively). The designation of papillary predominant subtype in the low-grade group, along with lepidic- and acinar predominant subtype had more prognostic significance than the model of combining papillary-, solid- and micropapillary predominant subtypes as the high-grade group (P = 0.005 versus P = 0.181). This high-grade group has increased risk of recurrence in a multivariate Cox regression (adjusted HR 2.815, 95% CI: 1.239 to 6.397, P = 0.013), and is associated significantly more with male gender (adjusted OR 2.214, 95% CI: 1.050 to 4.668, P = 0.037), and, with borderline significance, the presence of LVI (adjusted OR 2.091, 95% CI: 0.938 to 4.662, P = 0.071). Conclusions Our results showed that the solid- and micropapillary predominant subtype of IASLC/ATS/ERS classification remains the only risk factor for post-operative recurrence of T1aN0M0 adenocarcinomas, suggesting that they can be indicators of aggressive tumor behaviors.
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Affiliation(s)
| | | | | | | | | | | | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, 11 Xizhimen Nan Ave, Beijing 100044, China.
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Jamal-Hanjani M, Hackshaw A, Ngai Y, Shaw J, Dive C, Quezada S, Middleton G, de Bruin E, Le Quesne J, Shafi S, Falzon M, Horswell S, Blackhall F, Khan I, Janes S, Nicolson M, Lawrence D, Forster M, Fennell D, Lee SM, Lester J, Kerr K, Muller S, Iles N, Smith S, Murugaesu N, Mitter R, Salm M, Stuart A, Matthews N, Adams H, Ahmad T, Attanoos R, Bennett J, Birkbak NJ, Booton R, Brady G, Buchan K, Capitano A, Chetty M, Cobbold M, Crosbie P, Davies H, Denison A, Djearman M, Goldman J, Haswell T, Joseph L, Kornaszewska M, Krebs M, Langman G, MacKenzie M, Millar J, Morgan B, Naidu B, Nonaka D, Peggs K, Pritchard C, Remmen H, Rowan A, Shah R, Smith E, Summers Y, Taylor M, Veeriah S, Waller D, Wilcox B, Wilcox M, Woolhouse I, McGranahan N, Swanton C. Tracking genomic cancer evolution for precision medicine: the lung TRACERx study. PLoS Biol 2014; 12:e1001906. [PMID: 25003521 PMCID: PMC4086714 DOI: 10.1371/journal.pbio.1001906] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The importance of intratumour genetic and functional heterogeneity is increasingly recognised as a driver of cancer progression and survival outcome. Understanding how tumour clonal heterogeneity impacts upon therapeutic outcome, however, is still an area of unmet clinical and scientific need. TRACERx (TRAcking non-small cell lung Cancer Evolution through therapy [Rx]), a prospective study of patients with primary non-small cell lung cancer (NSCLC), aims to define the evolutionary trajectories of lung cancer in both space and time through multiregion and longitudinal tumour sampling and genetic analysis. By following cancers from diagnosis to relapse, tracking the evolutionary trajectories of tumours in relation to therapeutic interventions, and determining the impact of clonal heterogeneity on clinical outcomes, TRACERx may help to identify novel therapeutic targets for NSCLC and may also serve as a model applicable to other cancer types.
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Affiliation(s)
- Mariam Jamal-Hanjani
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
- Department of Medical Oncology, University College London Hospitals, London, United Kingdom
| | - Alan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - Yenting Ngai
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - Jacqueline Shaw
- Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom
| | - Caroline Dive
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Sergio Quezada
- Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, United Kingdom
| | - Gary Middleton
- Department of Medical Oncology, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Elza de Bruin
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
| | - John Le Quesne
- Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom
| | - Seema Shafi
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
| | - Mary Falzon
- Department of Pathology, University College London Hospitals, London, United Kingdom
| | - Stuart Horswell
- Department of Bioinformatics and BioStatistics, Cancer Research UK, London Research Institute, London, United Kingdom
| | - Fiona Blackhall
- Institute of Cancer Studies, University of Manchester and The Christie Hospital, Manchester, United Kingdom
| | - Iftekhar Khan
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - Sam Janes
- Department of Respiratory Medicine, University College London Hospitals, London, United Kingdom
| | - Marianne Nicolson
- Department of Medical Oncology, Aberdeen University Medical School & Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - David Lawrence
- Department of Cardiothoracic Surgery, Heart Hospital, London, United Kingdom
| | - Martin Forster
- Department of Medical Oncology, University College London Hospitals, London, United Kingdom
| | - Dean Fennell
- Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom
- Department of Medical Oncology, University of Leicester & Leicester University Hospitals, Leicester, United Kingdom
| | - Siow-Ming Lee
- Department of Medical Oncology, University College London Hospitals, London, United Kingdom
| | - Jason Lester
- Department of Clinical Oncology, Velindre Hospital, Cardiff, Wales, United Kingdom
| | - Keith Kerr
- Department of Pathology, Aberdeen University Medical School & Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Salli Muller
- Department of Pathology, University of Leicester & Leicester University Hospitals, Leicester, United Kingdom
| | - Natasha Iles
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - Sean Smith
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - Nirupa Murugaesu
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
- Department of Medical Oncology, University College London Hospitals, London, United Kingdom
| | - Richard Mitter
- Department of Bioinformatics and BioStatistics, Cancer Research UK, London Research Institute, London, United Kingdom
| | - Max Salm
- Department of Bioinformatics and BioStatistics, Cancer Research UK, London Research Institute, London, United Kingdom
| | - Aengus Stuart
- Department of Bioinformatics and BioStatistics, Cancer Research UK, London Research Institute, London, United Kingdom
| | - Nik Matthews
- The Advanced Sequencing Facility, London Research Institute, London, United Kingdom
| | - Haydn Adams
- Department of Radiology, University Hospital Llandough, Cardiff, Wales, United Kingdom
| | - Tanya Ahmad
- Department of Medical Oncology, University College London Hospitals, London, United Kingdom
| | - Richard Attanoos
- Department of Pathology, University Hospital Llandough, Cardiff, Wales, United Kingdom
| | - Jonathan Bennett
- Department of Respiratory Medicine, University of Leicester & Leicester University Hospitals, Leicester, United Kingdom
| | - Nicolai Juul Birkbak
- Department of Systems Biology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Richard Booton
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, United Kingdom
| | - Ged Brady
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Keith Buchan
- Department of Cardiothoracic Surgery, Aberdeen University Medical School & Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Arrigo Capitano
- Department of Pathology, University College London Hospitals, London, United Kingdom
| | - Mahendran Chetty
- Department of Respiratory Medicine, Aberdeen University Medical School & Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Mark Cobbold
- Department of Clinical Immunology, University of Birmingham, Birmingham, B15 2TT
| | - Philip Crosbie
- North West Lung Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Helen Davies
- Department of Respiratory Medicine, University Hospital Llandough, Cardiff, Wales, United Kingdom
| | - Alan Denison
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, United kingdom
| | - Madhav Djearman
- Department of Radiology, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Jacki Goldman
- Department of IT, London Research Institute, London, United Kingdom
| | - Tom Haswell
- Independent Cancer Patient's Voice, London, united Kingdom
| | - Leena Joseph
- Department of Pathology, University Hospitals of South Manchester, Manchester
| | - Malgorzata Kornaszewska
- Department of Cardiothoracic Surgery, University Hospital Llandough, Cardiff, Wales, United Kingdom
| | - Matthew Krebs
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Gerald Langman
- Department of Cellular Pathology, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | | | - Joy Millar
- Department of Respiratory Medicine, Aberdeen University Medical School & Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Bruno Morgan
- Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom
| | - Babu Naidu
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Daisuke Nonaka
- Department of Pathology, University Hospitals of South Manchester, Manchester
- The Christie Hospital, Manchester, United Kingdom
| | - Karl Peggs
- Immune Regulation and Tumour Immunotherapy Laboratory, University College London Cancer Institute, London, United Kingdom
| | - Catrin Pritchard
- Department of Biochemistry, University of Leicester, Leicester, United Kingdom
| | - Hardy Remmen
- Department of Cardiothoracic Surgery, Aberdeen University Medical School & Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Andrew Rowan
- Translational Cancer Therapeutics Laboratory, London Research Institute, London, United Kingdom
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, University Hospitals of South Manchester, Manchester, United Kingdom
| | - Elaine Smith
- Department of Radiology, University Hospitals of South Manchester, Manchester, United Kingdom
| | - Yvonne Summers
- The Christie Hospital, Manchester, United Kingdom
- Department of Medical Oncology, University Hospital of South Manchester, Manchester, United Kingdom
| | - Magali Taylor
- Department of Radiology, University College London Hospitals, London, United Kingdom
| | - Selvaraju Veeriah
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
| | - David Waller
- Department of Cardiothoracic Surgery, University of Leicester & Leicester University Hospitals, Leicester, United Kingdom
| | - Ben Wilcox
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maggie Wilcox
- Independent Cancer Patient's Voice, London, united Kingdom
| | - Ian Woolhouse
- Department of Respiratory Medicine, Birmingham University Hospital, Birmingham, United Kingdom
| | - Nicholas McGranahan
- Translational Cancer Therapeutics Laboratory, London Research Institute, London, United Kingdom
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, University College London Cancer Institute, London, United Kingdom
- Department of Medical Oncology, University College London Hospitals, London, United Kingdom
- Translational Cancer Therapeutics Laboratory, London Research Institute, London, United Kingdom
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Prognostic significance of adenocarcinoma in situ, minimally invasive adenocarcinoma, and nonmucinous lepidic predominant invasive adenocarcinoma of the lung in patients with stage I disease. Am J Surg Pathol 2014; 38:448-60. [PMID: 24472852 DOI: 10.1097/pas.0000000000000134] [Citation(s) in RCA: 186] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
According to the IASLC/ATS/ERS classification, the lepidic predominant pattern consists of 3 subtypes: adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and nonmucinous lepidic predominant invasive adenocarcinoma. We reviewed tumor slides from 1038 patients with stage I lung adenocarcinoma, recording the percentage of each histologic pattern and measuring the invasive tumor size. Tumors were classified according to the IASLC/ATS/ERS classification: 2 were AIS, 34 MIA, and 103 lepidic predominant invasive. Cumulative incidence of recurrence (CIR) was used to estimate the probability of recurrence. Patients with AIS and MIA experienced no recurrences. Patients with lepidic predominant invasive tumors had a lower risk for recurrence (5-y CIR, 8%) than nonlepidic predominant tumors (n=899; 19%; P=0.003). Patients with >50% lepidic pattern tumors experienced no recurrences (n=84), those with >10% to 50% lepidic pattern tumors had an intermediate risk for recurrence (n=344; 5-y CIR, 12%), and those with ≤10% lepidic pattern tumors had the highest risk (n=610; 22%; P<0.001). CIR was lower for patients with ≤2 cm tumors than for those with >2 to 3 cm tumors (for both total and invasive tumor size), with the difference more pronounced for invasive tumor size (5-y CIR, 13% vs. 21% [total size; P=0.022] and 12% vs. 27% [invasive size; P<0.001]). Most patients with lepidic predominant adenocarcinoma who experienced a recurrence had potential risk factors, including sublobar resection with close margins (≤0.5 cm; n=2), 20% to 30% micropapillary component (n=2), and lymphatic or vascular invasion (n=2). It therefore may be possible to identify lepidic predominant adenocarcinomas that carry a low or high risk for recurrence.
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Kadota K, Yeh YC, Sima CS, Rusch VW, Moreira AL, Adusumilli PS, Travis WD. The cribriform pattern identifies a subset of acinar predominant tumors with poor prognosis in patients with stage I lung adenocarcinoma: a conceptual proposal to classify cribriform predominant tumors as a distinct histologic subtype. Mod Pathol 2014; 27:690-700. [PMID: 24186133 PMCID: PMC4374572 DOI: 10.1038/modpathol.2013.188] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 12/16/2022]
Abstract
The 2011 International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) lung adenocarcinoma classification emphasizes the prognostic significance of histologic subtypes. However, one limitation of this classification is that the highest percentage of patients (∼40%) is classified as acinar predominant tumors, and these patients display a spectrum of favorable and unfavorable clinical behaviors. We investigated whether the cribriform pattern can further stratify prognosis by histologic subtype. Tumor slides from 1038 patients with stage I lung adenocarcinoma (1995-2009) were reviewed. Tumors were classified according to the IASLC/ATS/ERS classification. The percentage of cribriform pattern was recorded, and the cribriform predominant subtype was considered as a subtype for analysis. The log-rank test was used to analyze the association between histologic variables and recurrence-free probability. The 5-year recurrence-free probability for patients with cribriform predominant tumors (n=46) was 70%. The recurrence-free probability for patients with cribriform predominant tumors was significantly lower than that for patients with acinar (5-year recurrence-free probability, 87%; P=0.002) or papillary predominant tumors (83%; P=0.020) but was comparable to that for patients with micropapillary (P=0.34) or solid predominant tumors (P=0.56). The recurrence-free probability for patients with ≥10% cribriform pattern tumors (n=214) was significantly lower (5-year recurrence-free probability, 73%) than that for patients with <10% cribriform pattern tumors (n=824; 84%; P<0.001). In multivariate analysis, patients with acinar predominant tumors with ≥10% cribriform pattern remained at significantly increased risk of recurrence compared with those with <10% cribriform pattern (P=0.042). Cribriform predominant tumors should be considered a distinct subtype with a high risk of recurrence, and presence (≥10%) of the cribriform pattern is an independent predictor of recurrence, identifying a poor prognostic subset of acinar predominant tumors. Our findings highlight the important prognostic value of comprehensive histologic subtyping and recording the percentage of each histologic pattern, according to the IASLC/ATS/ERS classification with the addition of the cribriform subtype.
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Affiliation(s)
- Kyuichi Kadota
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York,Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York,Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yi-Chen Yeh
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Camelia S. Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Valerie W. Rusch
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andre L. Moreira
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Prasad S. Adusumilli
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York,Center for Cell Engineering, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - William D. Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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75
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Hwang I, Park KU, Kwon KY. Modified Histologic Classification as a Prognostic Factor in Pulmonary Adenocarcinoma. Int J Surg Pathol 2014; 22:212-20. [DOI: 10.1177/1066896914525230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background. The histologic pattern of pulmonary adenocarcinoma is highly heterogeneous and considered to be an important prognostic factor. The predominant histologic pattern is emphasized in the 2011 International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society classification, but few studies present a detailed investigation of the histologic changes and prognosis pulmonary adenocarcinoma using resected specimens. Methods. We examined 125 cases of surgically resected pulmonary adenocarcinoma and carefully observed histologic patterns. Invasive adenocarcinoma was divided into 3 groups according to a modified histologic classification system: group 1 had a lepidic or papillary predominant pattern with ≤10% solid or micropapillary pattern; group 2 had an acinar predominant pattern with ≤10% of the solid or micropapillary pattern; and group 3 had a solid or micropapillary predominant pattern, or any predominant pattern with >10% solid or micropapillary pattern. Results. Proportions of predominant lepidic, papillary, acinar, solid, and micropapillary patterns were 11 (9.3%), 8 (6.8%), 54 (45.8%), 38 (32.2%), and 7 (5.9%), respectively. Vague areas between 2 different patterns were frequently observed, which were considered as transitional areas for one pattern to the other pattern (gradual dedifferentiation). Modified histologic classification was significantly associated with disease-free and overall survival rate ( P = .026 and .010, respectively) using the Kaplan–Meier survival test, and an independent prognostic factor ( P = .016) in overall survival using the Cox regression test. Conclusion. Pulmonary adenocarcinoma demonstrates heterogeneous histologic patterns with gradual dedifferentiation, and this modified histologic classification is an important prognostic factor for patients with pulmonary adenocarcinoma.
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Affiliation(s)
- Ilseon Hwang
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Keon Uk Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kun Young Kwon
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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Rozensztajn N, Ruppert AM, Lavole A, Leprieur EG, Duruisseaux M, Vieira T, Rabbe N, Lacave R, Antoine M, Cadranel J, Wislez M. Factors associated with early progression of non-small-cell lung cancer treated by epidermal growth factor receptor tyrosine-kinase inhibitors. Cancer Med 2014; 3:61-9. [PMID: 24408092 PMCID: PMC3930390 DOI: 10.1002/cam4.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/19/2013] [Accepted: 11/20/2013] [Indexed: 12/30/2022] Open
Abstract
Epidermal growth factor receptor tyrosine-kinase inhibitors (EGFR-TKI) are a therapeutic option as second-line therapy in non-small-cell lung carcinoma (NSCLC), regardless of the EGFR gene status. Identifying patients with early progression during EGFR-TKI treatment will help clinicians to choose the best regimen, TKI or chemotherapy. From a prospective database, all patients treated with gefitinib or erlotinib between 2001 and 2010 were retrospectively reviewed. Patients were classified into two groups according to their tumor response by RECIST after 45 days of treatment, progressive disease (PD) or controlled disease (CD). Two hundred and sixty-eight patients were treated with EGFR-TKI, among whom 239 were classified as PD (n = 75) and CD (n = 164). Median overall survival was 77 days (95% CI 61-109) for PD and 385 days (95% CI 267-481) for CD. Patients with PD were of younger age (P = 0.004) and more frequently current smokers (P = 0.001) had more frequently a performance status ≥2 (P = 0.012), a weight loss ≥10% (P = 0.025), a shorter time since diagnosis (P < 0.0001), a pathological classification as non-otherwise-specified NSCLC (P = 0.01), and the presence of abdominal metastases (P = 0.008). In multivariate analysis, abdominal metastases were the only factor associated with early progression (odds ratio (OR) 2.17, 95% CI [1.12-4.19]; P = 0.021). Wild-type EGFR versus mutated EGFR was associated with early progression. The presence of abdominal metastasis was independently associated with early progression in metastatic NSCLC receiving EGFR-TKI.
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Affiliation(s)
- Nathalie Rozensztajn
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Anne-Marie Ruppert
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Armelle Lavole
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Etienne Giroux Leprieur
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Michael Duruisseaux
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Thibault Vieira
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Nathalie Rabbe
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Roger Lacave
- Plateforme de Biologie moléculaire, Service de Cytologie et Biologie Tumorale, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Martine Antoine
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
- Service d'Anatomie Pathologique, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Jacques Cadranel
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Marie Wislez
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
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Wang C, Durra HY, Huang Y, Manucha V. Interobserver Reproducibility Study of the Histological Patterns of Primary Lung Adenocarcinoma With Emphasis on a More Complex Glandular Pattern Distinct From the Typical Acinar Pattern. Int J Surg Pathol 2014; 22:149-55. [DOI: 10.1177/1066896913519165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The newly proposed International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) classification of lung adenocarcinoma has emphasized the prognostic significance of histological subtyping. In this study, 2 surgical pathologists reevaluated 49 consecutive cases of invasive primary pulmonary adenocarcinomas; histological subtyping was performed according to the IASLC/ATS/ERS classification. The 2 reviewers agreed on the predominant pattern in 23 out of 32 independently reviewed cases (71.9%, k = 0.628, 95% confidence interval = 0.442-0.815). Postconsensus, a complex glandular pattern consisting of fused, closely packed glands and cribriform architecture was identified in 9 of 49 (18%) cases. This pattern has a strong association with lymphovascular invasion (78%; P = .0091), high mitotic activity (89%), and higher tumor stage (78%). Frequent association of complex glandular pattern with poor prognostic factors and its overlap with acinar pattern warrant a more detailed description of this pattern in the classification system and a large-scale study to evaluate its prognostic significance.
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Affiliation(s)
- Congli Wang
- Temple University Hospital, Philadelphia, PA, USA
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78
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Hu HD, Wan MY, Xu CH, Zhan P, Zou J, Zhang QQ, Zhang YQ. Histological subtypes of solitary pulmonary nodules of adenocarcinoma and their clinical relevance. J Thorac Dis 2014; 5:841-6. [PMID: 24409363 DOI: 10.3978/j.issn.2072-1439.2013.12.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/10/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To explore the histological subtypes of solitary pulmonary nodules (SPNs) of invasive adenocarcinoma and their clinical relevance. METHODS A total of 188 patients with pathologically confirmed invasive adenocarcinoma in our hospital from January 2007 to December 2011 were enrolled in this study. In accordance with the new classification of lung adenocarcinoma, all the histological sections were reviewed and classified, and the clinical data were collected and analyzed. RESULTS Of these 188 patients who had been initially diagnosed as SPNs of adenocarcinoma, there were 6 cases of lepidic predominant adenocarcinoma (LPA), 71 cases of acinar predominant adenocarcinoma (APA), 74 cases of papillary predominant adenocarcinoma (PPA), 15 cases of micorpapillary predominant adenocarcinoma (MPA), and 22 cases of solid predominant adenocarcinoma (SPA) with mucin production. The incidence of lymph node metastasis was 80.0% and 81.8% in MPA and SPA, respectively, which was significantly higher than those in LPA, APA, and PPA (all P<0.01). The incidence of LPA was 83.3% (5/6) in women, which was significantly higher than that in men (P=0.037). CONCLUSIONS According to the new classification, MPA and SPA have high incidence of lymph node metastasis. LPA is more likely to occur in women. Sub-typing of the lung adenocarcinoma based on the newest international classification criteria is helpful to identify the clinical features of this disease.
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Affiliation(s)
- Hui-Di Hu
- Department of Pathology, Nanjing Chest Hospital, Nanjing 210029, China
| | - Ming-Yue Wan
- Department of Pathology, Nanjing Chest Hospital, Nanjing 210029, China
| | - Chun-Hua Xu
- Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing 210029, China; ; Nanjing Clinical Center of Respiratory Diseases, Nanjing 210029, China
| | - Ping Zhan
- Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing 210029, China; ; Nanjing Clinical Center of Respiratory Diseases, Nanjing 210029, China
| | - Jue Zou
- Department of Pathology, Nanjing Chest Hospital, Nanjing 210029, China
| | - Qian-Qian Zhang
- Department of Pathology, Nanjing Chest Hospital, Nanjing 210029, China
| | - Yuan-Qing Zhang
- Department of Pathology, Nanjing Chest Hospital, Nanjing 210029, China
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Sun H, Guo J, Liu Y, Wang Z. Classification and regression tree analysis of patients with non-small-cell lung cancer treated with gefitinib after chemotherapy. Thorac Cancer 2013; 4:280-286. [PMID: 28920234 DOI: 10.1111/1759-7714.12014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/25/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many randomized studies have shown that epidermal growth factor receptor (EGFR-) tyrosine kinase inhibitors (TKIs) are apparently advantageous over standard chemotherapy in non-small-cell lung cancer (NSCLC) patients with EGFR active mutation in front-line treatment. But which subgroup of advanced NSCLC could benefit from EGFR-TKIs in the second-or third-line setting remains elusive. To explore predictive factors of advanced NSCLC patients with the unknown status of EGFR mutation treated by gefitinib in the second-or third-line setting, we used classification and regression tree (CART) analysis to screen which patients would benefit more. METHODS One hundred and fifty-five patients with advanced NSCLC previously unsuccessfully treated with platinum-based chemotherapy were included in this study. Patients received gefitinib as part of the Expanded Access Program of the China Charity Federation between 2 March 2005 and 11 May 2011. Multivariate analysis of progression-free survival (PFS) was performed using CART analysis. This method uses recursive partitioning to assess the effect of specific variables on PFS, thereby ultimately generating groups of patients with similar clinical features on PFS. RESULTS The median PFS in patients with NSCLC who were treated with gefitinib after prior chemotherapy was 16 months (95% confidence interval [CI] 13.44-18.56). CART was performed with an initial split on adenocarcinoma differentiation, and four terminal subgroups were formed. The median PFS of the four subsets ranged from 12 to 42 months. CONCLUSIONS Adenocarcinoma differentiation, brain metastasis and prior thoracic radiotherapy are predictors of PFS in previously treated NSCLC patients. CART can be used to identify homogeneous patient populations in clinical practice and future clinical trials.
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Affiliation(s)
- Hongyan Sun
- Department of Medical Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingfeng Guo
- Hexian Affiliated Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Yutao Liu
- Department of Medical Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ziping Wang
- Department of Medical Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol 2013; 8:52-61. [PMID: 23242438 DOI: 10.1097/jto.0b013e3182769aa8] [Citation(s) in RCA: 340] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study aimed to validate the utility of the new histological classification proposed by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS) for identifying the prognostic subtypes of adenocarcinomas in Japanese patients; correlations between the classification and the presence of EGFR or KRAS mutation status were also investigated. METHODS We retrospectively reviewed 440 patients with lung adenocarcinoma, who underwent resection. The tumors were classified according to the IASLC/ATS/ERS classification. EGFR and KRAS mutations were detected using the established methods. RESULTS Five-year disease-free survival rates were: 100% for adenocarcinoma in situ (n = 20) and minimally invasive adenocarcinoma (n = 33), 93.8% for lepidic-predominant adenocarcinoma (n = 36), 88.8% for invasive mucinous adenocarcinoma (n = 10), 66.7% for papillary-predominant adenocarcinoma (n = 179), 69.7% for acinar-predominant adenocarcinoma (n = 61), 43.3% for solid-predominant adencoarcinoma (n = 78), and 0% for micropapillary-predominant adenocarcinoma (n = 19). Multivariate analysis revealed that the new classification was an independent predictor of disease-free survival. EGFR and KRAS mutations were detected in 90 cases (53.9%) and 21 cases (13.3%), respectively; EGFR mutations were significantly associated with adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic- and papillary-predominant adenocarcinoma, and KRAS mutations adenocarcinomas with mucinous tumor subtypes. CONCLUSIONS We found that the IASLC/ATS/ERS classification identified prognostic histologic subtypes of lung adenocarcinomas among Japanese patients. Histologic subtyping and molecular testing for EGFR and KRAS mutations can help predict patient prognosis and select those who require adjuvant chemotherapy.
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81
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Hwang DH, Szeto DP, Perry AS, Bruce JL, Sholl LM. Pulmonary large cell carcinoma lacking squamous differentiation is clinicopathologically indistinguishable from solid-subtype adenocarcinoma. Arch Pathol Lab Med 2013; 138:626-35. [PMID: 23738762 DOI: 10.5858/arpa.2013-0179-oa] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Pulmonary large cell carcinoma (LCC) includes tumors not readily diagnosed as adenocarcinoma (ADC) or squamous cell carcinoma on morphologic grounds, without regard to immunophenotype, according to the World Health Organization (WHO). This ambiguous designation may cause confusion over selection of mutation testing and directed therapies. Several groups have proposed the use of immunohistochemistry (IHC) to recategorize LCC as ADC or squamous cell carcinoma; however, it remains unclear if strictly defined LCCs are a clinicopathologically distinct lung tumor subset. OBJECTIVE To compare the pathologic, molecular, and clinical features of 2 morphologically similar tumors: solid-subtype ADC and LCC. DESIGN Tumors were included on the basis of solid growth pattern; tumors with squamous or neuroendocrine differentiation were excluded. Solid ADC (n = 42) and LCC (n = 57) were diagnosed by using WHO criteria (5 intracellular mucin droplets in ≥2 high-power fields for solid ADC) and tested for KRAS, EGFR, and ALK alterations. RESULTS Both solid ADC and LCC groups were dominated by tumors with "undifferentiated"-type morphology and both had a high frequency of thyroid transcription factor 1 expression. KRAS was mutated in 38% of solid ADCs versus 43% of LCCs (P = .62). One ALK-rearranged and 1 EGFR-mutated tumor were detected in the solid ADC and LCC groups, respectively. There were no significant differences in clinical features or outcomes; the prevalence of smoking in both groups was greater than 95%. CONCLUSIONS Other than a paucity of intracellular mucin, LCC lacking squamous or neuroendocrine differentiation is indistinguishable from solid-subtype ADC. We propose the reclassification of these tumors as mucin-poor solid adenocarcinomas.
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Affiliation(s)
- David H Hwang
- Published as an Early Online Release June 5, 2013. From the Department of Pathology (Drs Hwang, Bruce, and Sholl, and Mr Szeto) and Center for Advanced Molecular Diagnostics (Mr Szeto and Drs Bruce and Sholl), Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts (Drs Hwang and Sholl); and the Department of Pathology, Banner MD Anderson Cancer Center, Gilbert, Arizona (Dr Perry)
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Subtyping Lung Adenocarcinoma According to the Novel 2011 IASLC/ATS/ERS Classification. Thorac Surg Clin 2013; 23:179-86. [DOI: 10.1016/j.thorsurg.2013.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Nakatani Y, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137:685-705. [PMID: 22913371 DOI: 10.5858/arpa.2012-0264-ra] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new lung adenocarcinoma classification has been published by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. This new classification is needed to provide uniform terminology and diagnostic criteria, most especially for bronchioloalveolar carcinoma. It was developed by an international core panel of experts representing all 3 societies with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons.This summary focuses on the aspects of this classification that address resection specimens. The terms bronchioloalveolar carcinoma and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced, such as adenocarcinoma in situ and minimally invasive adenocarcinoma for small solitary adenocarcinomas with either pure lepidic growth (adenocarcinoma in situ) and predominant lepidic growth with invasion of 5 mm or less (minimally invasive adenocarcinoma), to define the condition of patients who will have 100% or near 100% disease-specific survival, respectively, if they undergo complete lesion resection. Adenocarcinoma in situ and minimally invasive adenocarcinoma are usually nonmucinous, but rarely may be mucinous. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous bronchioloalveolar carcinoma), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous bronchioloalveolar carcinoma), colloid, fetal, and enteric adenocarcinoma.It is possible that this classification may impact the next revision of the TNM staging classification, with adjustment of the size T factor according to only the invasive component pathologically in adenocarcinomas with lepidic areas.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Lee HY, Jeong JY, Lee KS, Yi CA, Kim BT, Kang H, Kwon OJ, Shim YM, Han J. Histopathology of lung adenocarcinoma based on new IASLC/ATS/ERS classification: Prognostic stratification with functional and metabolic imaging biomarkers. J Magn Reson Imaging 2013; 38:905-13. [DOI: 10.1002/jmri.24080] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 01/22/2013] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ho Yun Lee
- Department of Radiology and Center for Imaging Science; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Ji Yun Jeong
- Department of Pathology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Chin A. Yi
- Department of Radiology and Center for Imaging Science; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Hee Kang
- Department of Radiology and Center for Imaging Science; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - O Jung Kwon
- Division of Respiratory and Critical Medicine of the Department of Internal Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Young Mog Shim
- Department of Thoracic Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Joungho Han
- Department of Pathology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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Onozato ML, Kovach AE, Yeap BY, Morales-Oyarvide V, Klepeis VE, Tammireddy S, Heist RS, Mark EJ, Dias-Santagata D, Iafrate AJ, Yagi Y, Mino-Kenudson M. Tumor islands in resected early-stage lung adenocarcinomas are associated with unique clinicopathologic and molecular characteristics and worse prognosis. Am J Surg Pathol 2013; 37:287-94. [PMID: 23095504 PMCID: PMC3545070 DOI: 10.1097/pas.0b013e31826885fb] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Tumor islands-large collections of tumor cells isolated within alveolar spaces-can be seen in lung adenocarcinomas. Recently we observed by 3-dimensional reconstruction that these structures were connected with each other and with the main tumor in different tissue planes, raising the possibility of tumor islands being a means of extension. However, the clinical and prognostic significance of tumor islands remains unknown. In this study, we compared clinicopathologic and molecular characteristics and prognosis of stages I to II lung adenocarcinomas with tumor islands (n=58) and those without (n=203). Lung adenocarcinomas with tumor islands were more likely to occur in smokers, exhibit higher nuclear grade and a solid or micropapillary pattern of growth, and harbor KRAS mutations. In contrast, lung adenocarcinomas without tumor islands were more likely to present as minimally invasive adenocarcinoma, show a lepidic pattern of growth, and harbor EGFR mutations. Although there was no difference in stage, the prognosis of lung adenocarcinomas with tumor islands was significantly worse than those without. The 5-year recurrence-free survival for patients with tumor islands and those without was 44.6% and 74.4%, respectively (log rank P=0.010). The survival difference remained significant (P <0.020) by multivariate analysis, and the presence of tumor islands was associated with almost 2-fold increase in the risk of recurrence. Even in the stage IA cohort, more than half of the patients with tumor islands experienced recurrence within 5 years. Thus, aggressive surveillance and/or further intervention may be indicated for patients whose tumors exhibit tumor islands.
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Affiliation(s)
- Maristela L Onozato
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
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Beljan Perak R, Durdov MG, Capkun V, Ivcevic V, Pavlovic A, Soljic V, Peric M. IMP3 can predict aggressive behaviour of lung adenocarcinoma. Diagn Pathol 2012. [PMID: 23190601 PMCID: PMC3533585 DOI: 10.1186/1746-1596-7-165] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Lung cancer most often presents as an inoperable tumour and the diagnosis is usually performed on a small biopsy/cytology specimen. In the group of non small cell lung cancer - not otherwise specified, adenocarcinoma phenotype can be determined immunohistochemically using TTF-1 and Napsin A. Expression of oncofetal protein IMP3 in human cancer is associated with poor differentiation and aggressive behaviour. In the present study expression of IMP3 was correlated with expression of TTF-1 and Napsin A, histological subtype and clinical stage of lung adenocarcinoma. We were interested whether distant metastases are associated with IMP3 overexpression, regardless of the histologic subtype of adenocarcinoma. Methods In retrospective study, consecutive series of 105 patients with advanced lung adenocarcinoma diagnosed from 2006 to 2009 in Clinical Hospital Center Split, Croatia, were analysed. Clinical data were collected from the Pulmology Department and time of death from the Mortality Registry. Paraffin blocks of bronchoscopic biopsies were collected from the Institute of Pathology and 15 cases excluded from the analysis due to insufficient material. Expression of IMP3, Napsin A and TTF-1 were analysed by indirect enzyme immunohistochemistry. Statistical analysis was performed and P values less than 0.05 considered significant. Results Of 90 patients, 71 (78%) were males and 19 (22%) females. Median age for males was 61.5 years (min-max 43–83) and for females 61 years (min-max 44–86). Pleural effusion was found in 15 (16.6%) and distant metastases in 45 (50%) cases. According to histological subtypes, there were 34 acinar, 2 lepidic, 2 papillary and 52 solid subtypes. IMP3 overexpression was found in 63 cases (70%) and was correlated with solid subtype (P = 0.002) and negative/weak Napsin A expression (P = 0.004). Strong Napsin A expression correlated with TTF-1 expression (P = 0.003) and lower histological grades (P = 0.031). Patients with IMP3 overexpression more often had distant metastases than patients with negative IMP3, 55.5% versus 33.3% (P = 0.033). Non solid subtypes with IMP3 overexpression developed distant metastasis more common than non solid subtypes with negative IMP3, 72% versus 35% (P = 0.028). Conclusions Expression of IMP3 correlates with solid subtype and with distant metastases regardless of histological subtype of lung adenocarcinoma. Virtual slides http://www.diagnosticpathology.diagnomx.eu/vs/1966211581795258 Zusammenfassung Hintergrund Das Lungenkarzinom kommt meistens als nicht resektabler Tumor vor und die Diagnose kann nur in kleinen Biopsaten oder zytologisch gestellt werden. In der Gruppe der nicht kleinzelligen Lungenkarzinome kann der nicht anders spezifizierte Adenokarzinom Phänotyp mit Hilfe der Antikörper TTF-1 und Napsin A diagnostiziert werden. Die Expression des onkoföetalen Proteins IMP3 ist bei humanen Karzinomen mit agressivem Verhalten und metastatischem Potential verbunden. In dieser Studie korreliert die Expression von IMP3 mit TTF-1, Napsin A, histologischem Typ und klinischem Staging des Lungenkarzinoms. Wir waren daran interessiert, ob Fernmetastasen mit IMP3 Überexpression assoziiert sind, unabhängig von der histologischen Subtyp von Adenokarzinom. Methode In der retrospektiven Studie wurden die von 2006 bis 2009 im Klinischem Krankenhaus Split, Kroatien diagnostizerte Adenokarzinome der Lunge von 105 Patienten analysiert. Die klinischen Daten stammten aus der Abteilung für Pulmologie und im Falle des Todes vom Todesregister. Die Paraffinblöcke der primären Lungenbiopsate dieser Patienten wurden im Institut für Pathologie mit der indirekter Enzym - Immunohistochemie mittels Kombination der Antikörper gegen IMP3, Napsin A und TTF1 untersucht. 15 Fälle aus der Analyse aufgrund unzureichender Material ausgeschlossen. Es wurde eine statistische Untersuchung durchgeführt und Werte weniger als 0.05 P wurden als statistisch signifikant bezeichnet. Ergebnisse Von 90 Patienten mit Lungencarcinom waren 71 (78%) mänlich, durchschnittliches Alter war für Männer 61.5 Jahre (min-max 43–83) und 61 Jahre für Frauen (min-max 44–86). Pleurale Effusionen fand man in 15 Fällen (16.6%) und Fernmetastasen in 45 (50%) Fällen. Histologische Sybtypen waren: 2 lepidic Karzinome, 34 azinäre Karzinome, 2 papilläre und 52 solide Karzinome. IMP3 war exprimiert in 63 Fälle (70%). Positive IMP3 Expression war mit solidem Typ (P = 0.002) und negativer Napsin A Expression (P = 0.004) assoziert. Napsin A Expression war mit niedrigem Gradus (P = 0.031) und positiver TTF-1 Expression (P = 0.003) assoziert. Patienten mit IMP3 Überexpression öfter hatten Fernmetastasen als Patienten mit negativen IMP3, 55.5% versus 33.3% (P = 0.033). Non solide Subtyp mit IMP3 Überexpression entwickelten Fernmetastasen Meer häufiger als nicht festem Subtyp mit negativen IMP3, 72% versus 35% (P = 0.028). Schlussworte Die Expression von IMP3 ist mit negaativer Expression von Napsin A, solidem Subtyp und Metastasen verbunden und hat praktische predictive Werte in der pathologischen Diagnose des Adenokarzinoms der Lunge. Die Expression von IMP3 korreliert mit soliden Subtyp und mit Fernmetastasen unabhängig von histologische Subtyp Lungenadenokarzinom.
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Affiliation(s)
- Renata Beljan Perak
- Institute for pathology, forensic medicine and cytology Clinical Hospital Center Split, Split, Croatia
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High SUVmax on FDG-PET indicates pleomorphic subtype in epithelioid malignant pleural mesothelioma: supportive evidence to reclassify pleomorphic as nonepithelioid histology. J Thorac Oncol 2012; 7:1192-7. [PMID: 22617244 DOI: 10.1097/jto.0b013e3182519d96] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We have recently proposed to reclassify the pleomorphic subtype of epithelioid malignant pleural mesothelioma (MPM) as nonepithelioid (biphasic/sarcomatoid) histology because of its similarly poor prognosis. We sought to investigate whether preoperative maximum standardized uptake value (SUVmax) on F-fluorodeoxyglucose (FDG) positron emission tomography (PET) correlates with histologic subtype in MPM. METHODS Clinical data were collected for 78 patients with MPM who underwent preoperative FDG-PET. We retrospectively classified the epithelioid tumors into five subtypes: trabecular, tubulopapillary, micropapillary, solid, and pleomorphic. Tumors were categorized by SUVmax into two groups: low (<10.0) and high (≥10.0). RESULTS The median overall survival of epithelioid tumors with high SUVmax (n = 12) was significantly shorter (7.1 months) than that of epithelioid tumors with low SUVmax (n = 54, 18.9 months, p < 0.001) and comparable to nonepithelioid tumors (n = 12, 7.2 months). Epithelioid tumors with pleomorphic subtype (n = 9) had marginally higher SUVmax (mean ± SD: 10.6 ± 5.9) than epithelioid nonpleomorphic subtype (n = 57, 6.5 ± 3.2, p = 0.050), and were comparable to that of nonepithelioid tumors (n = 12, 9.1 ± 4.8). Among the epithelioid tumors with high SUVmax (n = 12), 50% (n = 6) showed pleomorphic subtype. In contrast, among epithelioid tumors with low SUVmax (n = 54), 6% (n = 3) showed epithelioid pleomorphic subtypes (p = 0.001). A positive correlation between mitotic count and SUVmax was observed (r = 0.30, p = 0.010). CONCLUSIONS Pleomorphic subtype of epithelioid MPM showed higher SUVmax than the epithelioid nonpleomorphic subtype and was similar to nonepithelioid histology. Preoperative SUVmax on FDG-PET in epithelioid MPM can indicate patients with pleomorphic subtype with poor prognosis, supporting their reclassification as nonepithelioid.
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Abstract
Chromosomal rearrangements leading to constitutive activation of anaplastic lymphoma receptor tyrosine kinase (ALK) define a category of lung adenocarcinomas that may be amenable to targeted therapy with the ALK inhibitor crizotinib. Defining distinctive features of ALK-rearranged (ALK+) lung adenocarcinomas may help identify cases that merit molecular testing. However, data describing the morphologic features of ALK+ lung adenocarcinomas are conflicting and are primarily based on analysis of resected primary lung tumors. It is unclear whether the findings from prior studies are applicable to metastatic lung tumors or to small biopsy/cytology specimens. To address these issues, we examined resection, excision, small biopsy, and cytology cell block specimens from 104 ALK+ and 215 ALK- lung adenocarcinomas from primary and metastatic sites. All cases were evaluated for ALK rearrangements by fluorescence in situ hybridization. The predominant histologic subtypes and distinctive cytomorphologic features were assessed in each case. Primary ALK+ lung adenocarcinomas showed a significant association with solid, micropapillary, and papillary-predominant histologic patterns and tumor cells with a signet ring or hepatoid cytomorphology. Among metastatic lung tumors and small biopsy/cytology specimens, the only distinguishing morphologic feature of ALK+ tumors was the presence of signet ring cells. Based on these results, we developed a morphology-based scoring system for predicting ALK rearrangements in lung adenocarcinomas. The scoring system predicted ALK rearrangements in a new cohort of 78 lung adenocarcinomas (29 ALK+ and 49 ALK-) with a sensitivity of 88% and a specificity of 45%. In conclusion, ALK+ lung adenocarcinomas have distinctive morphologic features, with signet ring cells showing a significant association with ALK rearrangements irrespective of tumor site (primary vs metastatic) or specimen type. However, morphologic screening alone will not detect a minority of ALK+ lung adenocarcinomas, and the routine use of ancillary studies may be warranted to identify all patients who may benefit from crizotinib treatment.
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Kadota K, Colovos C, Suzuki K, Rizk NP, Dunphy MPS, Zabor EC, Sima CS, Yoshizawa A, Travis WD, Rusch VW, Adusumilli PS. FDG-PET SUVmax combined with IASLC/ATS/ERS histologic classification improves the prognostic stratification of patients with stage I lung adenocarcinoma. Ann Surg Oncol 2012; 19:3598-605. [PMID: 22644511 PMCID: PMC4049004 DOI: 10.1245/s10434-012-2414-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND We investigated the association between the newly proposed International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification and (18)F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET), and whether the combination of these radiologic and pathologic factors can further prognostically stratify patients with stage I lung adenocarcinoma. METHODS We retrospectively evaluated 222 patients with pathologic stage I lung adenocarcinoma who underwent FDG-PET scanning before undergoing surgical resection between 1999 and 2005. Patients were classified by histologic grade according to the IASLC/ATS/ERS classification (low, intermediate, or high grade) and by maximum standard uptake value (SUVmax) (low <3.0, high ≥3.0). The cumulative incidence of recurrence (CIR) was used to estimate recurrence probabilities. RESULTS Patients with high-grade histology had higher risk of recurrence (5-year CIR, 29% [n = 25]) than those with intermediate-grade (13% [n = 181]) or low-grade (11% [n = 16]) histology (p = 0.046). High SUVmax was associated with high-grade histology (p < 0.001) and with increased risk of recurrence compared to low SUVmax (5-year CIR, 21% [n = 113] vs. 8% [n = 109]; p = 0.013). Among patients with intermediate-grade histology, those with high SUVmax had higher risk of recurrence than those with low SUVmax (5-year CIR, 19% [n = 87] vs. 7% [n = 94]; p = 0.033). SUVmax was associated with recurrence even after adjusting for pathologic stage (p = 0.037). CONCLUSIONS SUVmax on FDG-PET correlates with the IASLC/ATS/ERS classification and can be used to stratify patients with intermediate-grade histology, the predominant histologic subtype, into two prognostic subsets.
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Affiliation(s)
- Kyuichi Kadota
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Christos Colovos
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kei Suzuki
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Nabil P. Rizk
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mark P. S. Dunphy
- Nuclear Medicine Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Emily C. Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Camelia S. Sima
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Akihiko Yoshizawa
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - William D. Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Valerie W. Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
- Center for Cell Engineering, Memorial Sloan-Kettering Cancer Center, New York, NY
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Gu J, Lu C, Guo J, Chen L, Chu Y, Ji Y, Ge D. Prognostic significance of the IASLC/ATS/ERS classification in Chinese patients-A single institution retrospective study of 292 lung adenocarcinoma. J Surg Oncol 2012; 107:474-80. [PMID: 22952152 DOI: 10.1002/jso.23259] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 08/13/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND A new classification of pulmonary adenocarcinoma has been recently proposed by the International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society (IASLC/ATS/ERS). This study was undertaken in an attempt to explore the clinical implication of this new classification in Chinese patients. METHODS Two hundred ninety-two lung adenocarcinomas were reclassified strictly according to the IASLC/ATS/ERS classification by two pathologists, independently. Kaplan-Meier and Cox regression analyses were used to analyze the correlation between the new classification and patients' prognosis. RESULTS We confirmed three groups with different outcomes. Both AIS and MIA had 100% 5-year disease-free survival rate and 100% 5-year overall survival rate. Lepidic, acinar, and papillary as well as variants of invasive adenocarcinoma had intermediate prognosis. Solid and micropapillary cases had poor prognosis (DFS: P < 0.001, OS: P = 0.002). After controlling the clinicopathological factors, the new classification was identified as an independent prognostic factor in patients' disease-free survival and overall survival. CONCLUSIONS We have demonstrated a valuable prognostic role of the new classification in Chinese patients. This new classification is valuable of screening out patients with high risk of recurrence to receive postoperative adjuvant therapy.
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Affiliation(s)
- Jie Gu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Kadota K, Suzuki K, Kachala SS, Zabor EC, Sima CS, Moreira AL, Yoshizawa A, Riely GJ, Rusch VW, Adusumilli PS, Travis WD. A grading system combining architectural features and mitotic count predicts recurrence in stage I lung adenocarcinoma. Mod Pathol 2012; 25:1117-27. [PMID: 22499226 PMCID: PMC4382749 DOI: 10.1038/modpathol.2012.58] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) has recently proposed a new lung adenocarcinoma classification. We investigated whether nuclear features can stratify prognostic subsets. Slides of 485 stage I lung adenocarcinoma patients were reviewed. We evaluated nuclear diameter, nuclear atypia, nuclear/cytoplasmic ratio, chromatin pattern, prominence of nucleoli, intranuclear inclusions, mitotic count/10 high-power fields (HPFs) or 2.4 mm(2), and atypical mitoses. Tumors were classified into histologic subtypes according to the IASLC/ATS/ERS classification and grouped by architectural grade into low (adenocarcinoma in situ, minimally invasive adenocarcinoma, or lepidic predominant), intermediate (papillary or acinar), and high (micropapillary or solid). Log-rank tests and Cox regression models evaluated the ability of clinicopathologic factors to predict recurrence-free probability. In univariate analyses, nuclear diameter (P=0.007), nuclear atypia (P=0.006), mitotic count (P<0.001), and atypical mitoses (P<0.001) were significant predictors of recurrence. The recurrence-free probability of patients with high mitotic count (≥5/10 HPF: n=175) was the lowest (5-year recurrence-free probability=73%), followed by intermediate (2-4/10 HPF: n=106, 80%), and low (0-1/10 HPF: n=204, 91%, P<0.001). Combined architectural/mitotic grading system stratified patient outcomes (P<0.001): low grade (low architectural grade with any mitotic count and intermediate architectural grade with low mitotic count: n=201, 5-year recurrence-free probability=92%), intermediate grade (intermediate architectural grade with intermediate-high mitotic counts: n=206, 78%), and high grade (high architectural grade with any mitotic count: n=78, 68%). The advantage of adding mitotic count to architectural grade is in stratifying patients with intermediate architectural grade into two prognostically distinct categories (P=0.001). After adjusting for clinicopathologic factors including sex, stage, pleural/lymphovascular invasion, and necrosis, mitotic count was not an independent predictor of recurrence (P=0.178). However, patients with the high architectural/mitotic grade remained at significantly increased risk of recurrence (high vs low: P=0.005) after adjusting for clinical factors. We proposed this combined architectural/mitotic grade for lung adenocarcinoma as a practical method that can be applied in routine practice.
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Affiliation(s)
- Kyuichi Kadota
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York,Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kei Suzuki
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stefan S. Kachala
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Emily C. Zabor
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Camelia S. Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andre L. Moreira
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Akihiko Yoshizawa
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York,Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Gregory J. Riely
- Thoracic Oncology Services, Division of Solid Tumor Oncology, Departments of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Valerie W. Rusch
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Prasad S. Adusumilli
- Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York,Center for Cell Engineering, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - William D. Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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Lee HY, Jeong JY, Lee KS, Kim HJ, Han J, Kim BT, Kim J, Shim YM, Kim JH, Song I. Solitary pulmonary nodular lung adenocarcinoma: correlation of histopathologic scoring and patient survival with imaging biomarkers. Radiology 2012; 264:884-93. [PMID: 22829686 DOI: 10.1148/radiol.12111793] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the usefulness of histopathologic scoring for survival prediction in patients with solitary pulmonary nodular (SPN) lung adenocarcinomas and to correlate the histopathologic scoring with the results of computed tomography (CT) and fluorine 18 fluorodeoxyglucose positron emission tomography (PET)/CT. MATERIALS AND METHODS This retrospective study was institutional review board approved and the requirement for informed consent was waived. A total of 148 patients with SPN lung adenocarcinoma underwent PET/CT and CT. Correlations between histopathologic scores estimated by using two predominant histologic subtypes from each surgically resected specimen and the mass of the nodule at CT or maximum standardized uptake value (SUV(max)) at PET/CT were assessed. Disease-free survival (DFS) was estimated by using the Kaplan-Meier method, and the log-rank test was used to evaluate differences in each histopathologic subtype. RESULTS In 135 (91%) patients, tumors had a mixed subtype. The most frequently observed histologic subtypes, in decreasing order, were acinar (51%), lepidic (18%), solid (10%), and papillary (9%). DFS rates at 5 years were higher than 90% for the group of patients with nodules that showed the lepidic growth pattern, and 50% for patients with nodules that showed the micropapillary pattern. The pathologic score proved to be a significant predictor of DFS (P < .001). Both SUV(max) and the mass of the nodule were closely correlated with pathologic score. CONCLUSION Pathologic scoring appears to help predict DFS in patients with SPN lung adenocarcinoma and shows close correlation with imaging biomarkers including the mass of the nodule at CT and SUV(max) at PET/CT.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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Kato F, Hamasaki M, Miyake Y, Iwasaki A, Iwasaki H, Nabeshima K. Clinicopathological characteristics of subcentimeter adenocarcinomas of the lung. Lung Cancer 2012; 77:495-500. [PMID: 22727683 DOI: 10.1016/j.lungcan.2012.05.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/14/2012] [Accepted: 05/22/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of subcentimeter adenocarcinoma is becoming easier due to recent advances in radiographic techniques. Pathological (p) T1a (≤20 mm) adenocarcinomas with a pure lepidic growth pattern have excellent prognosis, whereas invasive pT1a adenocarcinomas are associated with recurrence/metastasis despite their small size. Thus, an accurate pathological diagnosis is critical in such cases. This study examined the clinicopathological characteristics of subcentimeter adenocarcinomas, especially those associated with early invasive carcinomas. METHODS We retrospectively reviewed 595 adenocarcinomas including 66 subcentimeter carcinomas, which were then analyzed with reference to early invasive features. RESULTS Of the 66 subcentimeter tumors, 36 were invasive and 30 were noninvasive (adenocarcinoma in situ, AIS). Invasive carcinomas were significantly more frequent in males than females, and included 20 tumors with ≤5 mm invasion in greatest dimension (minimally invasive adenocarcinoma, MIA) and 16 tumors with >5mm invasion, 5 of which had no lepidic growth portions (entirely invasive carcinoma). Approximately half of the invasive carcinomas had no localized fibrous area ≥1 mm in diameter (LFA), and showed histological features of invasive carcinoma with localized lepidic growth including MIA (Noguchi's type C). Invasion was sometimes difficult to detect in these carcinomas. High-grade nuclear atypia was always associated with invasive carcinomas and aided the diagnosis. Moreover, invasive carcinoma with >5mm invasion was significantly associated with presence of metastasis in sensitivity analysis in patients followed for more than two years. Compared with adenocarcinomas of 11-20mm in diameter, subcentimeter carcinomas included significantly more AIS, fewer entirely invasive carcinomas, and fewer invasive carcinomas with LFA. CONCLUSIONS Familiarity with the histopathological characteristics of subcentimeter adenocarcinomas as described above could aid the accurate diagnosis of early invasive carcinomas.
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Affiliation(s)
- Fumiaki Kato
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
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Number of circulating endothelial progenitor cells and intratumoral microvessel density in non-small cell lung cancer patients: differences in angiogenic status between adenocarcinoma histologic subtypes. J Thorac Oncol 2012; 7:503-11. [PMID: 22198428 DOI: 10.1097/jto.0b013e318241780e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Angiogenesis plays a significant role in tumor progression. This study examined the association between the number of circulating endothelial progenitor cells (EPCs), intratumoral microvessel density (MVD) (both of which may be markers for neovascularization), and lung cancer histological types, particularly adenocarcinoma histological subtypes. METHODS A total of 83 stage I non-small cell lung cancer (NSCLC) patients underwent complete tumor resection between November 2009 and July 2010. The number of EPCs from the pulmonary artery of the resected lungs was measured by assaying CD34/vascular endothelial growth factor receptor 2 positive cells, and the MVD was assessed immunohistochemically in tumor specimens by staining for CD34. RESULTS A statistically significant correlation between the number of EPCs from pulmonary artery and intratumoral MVD was found (p < 0.001). No statistically significant differences in the number of EPCs and the MVD were observed between the adenocarcinomas and the squamous cell carcinomas. Among the adenocarcinoma histological subtypes, a higher number of EPCs and MVD were found significantly more frequently in solid adenocarcinomas than in nonsolid adenocarcinomas (p < 0.001 and p = 0.011, respectively). In addition, solid adenocarcinomas showed higher levels of vascular endothelial growth factor using quantitative real-time polymerase chain reaction in the tumor tissue samples than in the nonsolid adenocarcinomas (p = 0.005). CONCLUSION The higher number of circulating EPCs and the MVD of solid adenocarcinoma may indicate the presence of differences in the tumor angiogenic status between early-stage adenocarcinoma histological subtypes. Among adenocarcinoma patients, patients with solid adenocarcinoma may be the best candidates for antiangiogenic therapies.
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Takuwa T, Ishii G, Nagai K, Yoshida J, Nishimura M, Hishida T, Neri S, Hasegawa S, Ochiai A. Characteristic immunophenotype of solid subtype component in lung adenocarcinoma. Ann Surg Oncol 2012; 19:3943-52. [PMID: 22669454 DOI: 10.1245/s10434-012-2428-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lung adenocarcinomas represent a morphologically heterogeneous tumor composed of an admixture of different histologic subtypes (lepidic, papillary, acinar, and solid subtype). The presence of a solid subtype component is reported to be associated with a poorer prognosis. The aim of this study was to evaluate the characteristic immunophenotype of the solid subtype component compared with the immunophenotypes of other components. METHODS We analyzed the clinicopathological characteristics of stage I adenocarcinoma patients with predominant solid subtype disease. Furthermore, we immunostained adenocarcinomas with predominant lepidic, papillary, acinar, and solid subtype components (n = 23 each) for 10 molecular markers of tumor invasiveness and scored the results. RESULTS Patients showing predominance of the solid subtype component (solid subtype adenocarcinoma) had a poorer prognosis than those showing predominance of the lepidic, papillary, or acinar component. Lymphovascular invasion was more often detected in solid subtype tumors than in others. The solid subtype component showed a significantly stronger staining intensity of laminin-5 expression than the lepidic, papillary, and acinar components (P < 0.001, P < 0.001, and P = 0.016, respectively). The fibronectin and vimentin expression levels were also significantly higher in the solid subtype component than in other components. This immunostaining character was validated by using mixed-subtype adenocarcinomas containing all four components in the same tumor. CONCLUSIONS This study concluded that the solid subtype component in lung adenocarcinomas exhibit the invasive immunophenotype, including increased laminin-5 expression, compared with the other components, which may be associated with a poorer prognosis.
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Affiliation(s)
- Teruhisa Takuwa
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Wilkerson MD, Yin X, Walter V, Zhao N, Cabanski CR, Hayward MC, Miller CR, Socinski MA, Parsons AM, Thorne LB, Haithcock BE, Veeramachaneni NK, Funkhouser WK, Randell SH, Bernard PS, Perou CM, Hayes DN. Differential pathogenesis of lung adenocarcinoma subtypes involving sequence mutations, copy number, chromosomal instability, and methylation. PLoS One 2012; 7:e36530. [PMID: 22590557 PMCID: PMC3349715 DOI: 10.1371/journal.pone.0036530] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/03/2012] [Indexed: 12/11/2022] Open
Abstract
Background Lung adenocarcinoma (LAD) has extreme genetic variation among patients, which is currently not well understood, limiting progress in therapy development and research. LAD intrinsic molecular subtypes are a validated stratification of naturally-occurring gene expression patterns and encompass different functional pathways and patient outcomes. Patients may have incurred different mutations and alterations that led to the different subtypes. We hypothesized that the LAD molecular subtypes co-occur with distinct mutations and alterations in patient tumors. Methodology/Principal Findings The LAD molecular subtypes (Bronchioid, Magnoid, and Squamoid) were tested for association with gene mutations and DNA copy number alterations using statistical methods and published cohorts (n = 504). A novel validation (n = 116) cohort was assayed and interrogated to confirm subtype-alteration associations. Gene mutation rates (EGFR, KRAS, STK11, TP53), chromosomal instability, regional copy number, and genomewide DNA methylation were significantly different among tumors of the molecular subtypes. Secondary analyses compared subtypes by integrated alterations and patient outcomes. Tumors having integrated alterations in the same gene associated with the subtypes, e.g. mutation, deletion and underexpression of STK11 with Magnoid, and mutation, amplification, and overexpression of EGFR with Bronchioid. The subtypes also associated with tumors having concurrent mutant genes, such as KRAS-STK11 with Magnoid. Patient overall survival, cisplatin plus vinorelbine therapy response and predicted gefitinib sensitivity were significantly different among the subtypes. Conclusions/ Significance The lung adenocarcinoma intrinsic molecular subtypes co-occur with grossly distinct genomic alterations and with patient therapy response. These results advance the understanding of lung adenocarcinoma etiology and nominate patient subgroups for future evaluation of treatment response.
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Affiliation(s)
- Matthew D. Wilkerson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xiaoying Yin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Vonn Walter
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ni Zhao
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christopher R. Cabanski
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michele C. Hayward
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - C. Ryan Miller
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mark A. Socinski
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Internal Medicine, Division of Medical Oncology, Multidisciplinary Thoracic Oncology Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Alden M. Parsons
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Leigh B. Thorne
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Benjamin E. Haithcock
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Nirmal K. Veeramachaneni
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William K. Funkhouser
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Scott H. Randell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Cell and Molecular Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Philip S. Bernard
- Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Charles M. Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America, University of North Carolina at Chapel Hill, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America, Chapel Hill, North Carolina, United States of America
| | - D. Neil Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Internal Medicine, Division of Medical Oncology, Multidisciplinary Thoracic Oncology Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Warth A, Muley T, Meister M, Stenzinger A, Thomas M, Schirmacher P, Schnabel PA, Budczies J, Hoffmann H, Weichert W. The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol 2012; 30:1438-46. [PMID: 22393100 DOI: 10.1200/jco.2011.37.2185] [Citation(s) in RCA: 538] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Our aim was to analyze and validate the prognostic impact of the novel International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) proposal for an architectural classification of invasive pulmonary adenocarcinomas (ADCs) across all tumor stages. PATIENTS AND METHODS The architectural pattern of a large cohort of 500 patients with resected ADCs (stages I to IV) was retrospectively analyzed in 5% increments and classified according to their predominant architecture (lepidic, acinar, solid, papillary, or micropapillary), as proposed by the IASLC/ATS/ERS. Subsequently, histomorphologic data were correlated with clinical data, adjuvant therapy, and patient outcome. RESULTS Overall survival differed significantly between lepidic (78.5 months), acinar (67.3 months), solid (58.1 months), papillary (48.9 months), and micropapillary (44.9 months) predominant ADCs (P = .007). When patterns were lumped into groups, this resulted in even more pronounced differences in survival (pattern group 1, 78.5 months; group 2, 67.3 months; group 3, 57.2 months; P = .001). Comparable differences were observed for overall, disease-specific, and disease-free survival. Pattern and pattern groups were stage- and therapy-independent prognosticators for all three survival parameters. Survival differences according to patterns were influenced by adjuvant chemoradiotherapy; in particular, solid-predominant tumors had an improved prognosis with adjuvant radiotherapy. The predominant pattern was tightly linked to the risk of developing nodal metastases (P < .001). CONCLUSION Besides all recent molecular progress, architectural grading of pulmonary ADCs according to the novel IASLC/ATS/ERS scheme is a rapid, straightforward, and efficient discriminator for patient prognosis and may support patient stratification for adjuvant chemoradiotherapy. It should be part of an integrated clinical, morphologic, and molecular subtyping to further improve ADC treatment.
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Affiliation(s)
- Arne Warth
- University Hospital Heidelberg, Heidelberg, Germany.
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