非小细胞肺癌组织起源分子病理分类及其临床意义

Clinical Evaluation of A New Pathological Classification for Non-small Cell Lung Cancer Based on Histogenesis of Bronchial Tree

背景与目的近年来对肺癌研究的巨大发展,肺癌的病理学分类不断推陈出新。本研究旨在研究和验证非小细胞肺癌(non-small cell lung cancer,NSCLC)组织起源分子病理分类的临床价值和意义。方法通过免疫组织化学双染法对105例肺癌标本及正常肺组织进行P63/Napsin A、TTF-1/CK7标记,结合肿瘤免疫特征、组织学特点及正常肺组织的免疫特征,提出了NSCLC组织起源分子病理分类体系,将NSCLC分为支气管上皮癌、细支气管肺泡癌、肺泡细胞癌及分泌腺癌,并分析本分类与表皮生长因子受体(epidermal growth factor receptor,EGFR)突变及临床预后的关系。结果本分类体系下不同亚型NSCLC中EGFR突变及其类型具有相对特异性;生存分析表明该分类有助于NSCLC患者预后情况的判断。结论本研究提出的基于组织起源的NSCLC分类体系具有较好的临床实用价值。

Background and objective Due in part to remarkable advances over the past decade in our understanding of lung cancer, there is a pressing need for a revised classification. The aim of this study was to explore and verify the clinical significance of a new molecular classification of non-small cell lung cancer （NSCLC） on the basis of anatomic site of bronchial tree. Methods Double-immunohistochemistry were performed in 105 tumor samples paring with normal lung tissue from non-small cell lung cancer patients by using monoclonal antibody of P63/NapsinA and TFF-1/CKT. By comprehensively analyzing the express profiles of tumors and normal lung tissues, histological characteristics we proposed a brand new pathological classification based on histogenesis for NSCLC and divided them as： bronchiole epithelial cell carcinoma, bronchiole-alveolar cell carcinoma, alveolar cell carcinoma and secretory adenocarcinoma. And to analyze the relationship between this classification and epidermal growth factor receptor （EGFR） mutation and ognosis. Results Further investigation revealed that our new classification showed strong relevancy with EGFR mutations and effective indicators for prognosis. Conclusion The classification system for NSCLC proposed by our research group is convenient for pathological diagnosis and valuable in clinical application.