最新国际肺腺癌分类方法回顾性分析具有细支气管肺泡癌特征的肺腺癌209例

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

目的:探讨最新国际肺腺癌分类中肺腺癌各组织学亚型与预后的相关性。方法:收集天津医科大学附属肿瘤医院2000年1月至2005年12月间经手术切除、病理诊断为细支气管肺泡癌(bronchioloalveolar carcinoma,BAC)或伴有BAC成分的腺癌209例。按照肺癌新分类,对所有病例组织学切片进行复习和分类,同时进行临床资料的收集和随访。结果:原诊断BAC的209例病例中原位腺癌(adenocarcinoma in situ,AIS)20例,微小浸润性腺癌(minimally invasive adenocarcinoma,MIA)13例,鳞屑样生长方式为主型腺癌(Lepidic predominant adenocarcinoma,LPA)82例,乳头状和腺泡状为主型55例,实性型和微乳头为主型39例。随访发现,腺癌的组织学亚型与5年生存率有显著的相关性,AIS和MIA两组患者的5年生存率均为100%,且均无淋巴结转移;LPA患者5年生存率为54.5%;腺泡型和乳头型腺癌的患者比AIS、MIA、LPA三组预后差,而实性型和微乳头型的病例预后最差。结论:肺腺癌中AIS和MIA有独特的临床病理特征及较好的预后。对具有细支气管肺泡癌特征的肺腺癌,严格按照最新国际肺腺癌分类标准进行亚型分型,对指导临床治疗及预测预后有重要意义。

Objective： This work aims to investigate the correlation of the prognosis of lung adenocarcinoma （LAC） patients with their histologic subtype based on the new international classifications for lung adenocarcinoma. Methods： Data of 209 patients with bronchioloalveolar carcinoma （BAC） or adenocarcinoma patients with the BAC feature who underwent surgery in the Tianjin Medical University Cancer Institute and Hospital between January 2000 and December 2005 were reviewed. The clinicopathologic characteris- tics and prognosis of LAC were analyzed retrospectively. Results： Based on the new diagnostic criteria for LAC classification （pub- lished in 2011）, the 209 LAC cases were classified into five groups： a, 20 adenocarcinomas in situ （AIS, nonmucinous）; b, 13 minimally invasive adenocarcinomas （MIA）; c, 82 adenocarcinomas with a prominent lepidic growth pattern （LPAs）; d, 55 cases with predominant acinar and papillary adenocarcinoma, and 39 with predominant micropapillary adenocarcinomas and solid adenocarcinoma with mucin. The new LAC classification is correlated with the 5-year survival rate. AIS and MIA have more indolent clinical courses. Conclusion： AIS and MIA have distinct clinicopathologic characteristics and better prognosis. Therefore, successful diagnosis of the pulmonary adenocarcinoma with the features of BAC is critical for guiding clinical treatment and establishing a prognosis.