WHO组织学分类和IASLC分级系统对肺浸润性腺癌生物学行为的差异

Different effects of the WHO histological classification and IASLC grading system on the biological behavior of lung invasive adenocarcinoma

目的探讨WHO组织学分类和国际肺癌研究协会(International Association for the Study of Lung Cancer,IASLC)分级系统与肺浸润性腺癌临床病理特征的关系,比较两种分类方法对预测肺浸润性腺癌生物学行为的价值。方法收集148例手术切除的肺浸润性腺癌标本,根据WHO组织学分类和IASLC分级系统的诊断标准进行分类和分级。ROC曲线分析两种分类方法对肺浸润性腺癌淋巴结转移、脉管侵犯、神经侵犯、胸膜侵犯、气腔内扩散以及pTNM分期的预测价值。结果根据WHO组织学结构为主的分类:148例肺浸润性腺癌中贴壁型28例、腺泡型101例、乳头型7例、微乳头型2例、实体型10例;以组织学分类对应的病理分级:高分化28例、中分化108例、低分化12例。根据IASLC分级系统进行分类:148例肺浸润性腺癌中高分化26例、中分化56例、低分化66例。WHO组织学分类和IASLC分级系统与患者性别、肿瘤大小、脉管侵犯、淋巴结转移、气腔内扩散、胸膜侵犯和pTNM分期均相关。ROC曲线显示IASLC分级系统对脉管侵犯、淋巴结转移、气腔内扩散、胸膜侵犯的预测效能优于WHO组织学分类;在pTNM分期上,IASLC分级系统比WHO组织学分类差。结论IASLC分级系统与WHO组织学分类相比,其具有较好地预测肺腺癌临床生物学行为,应在临床实践中推广使用。

Purpose To analyze the relationship between the WHO histological classification and IASLC grading system and the clinicopathological parameters of lung invasive adenocarcinoma,and to explore and compare the value of the two classification methods in predicting the biological behavior of lung invasive adenocarcinoma.Methods A retrospective collection of 148 cases of lung invasive adenocarcinoma resected were observed and classified and graded according to the main WHO histological pattern and IASLC histological grade.The predictive value of the two classification for lymph node metastasis,vascular invasion,nerve invasion,pleural invasion,spreading through air spaces(STAS)and pTNM staging of lung invasive adenocarcinoma was analysed using ROC curve.Results Among the 148 cases of lung invasive adenocarcinoma,28 cases were lepidic type,101 cases were acinar type,7 cases were papillary type,2 cases were micropapillary type,and 10 cases were solid type according to the main WHO histological pattern.In the pathological classification based on the main histological pattern,28 cases were well-differentiated,108 cases were moderately-differentiated,and 12 cases were poorly-differentiated.According to the pathological classification of IASLC,26 cases were well-differentiated,56 cases were moderately-differentiated,and 66 cases were poorly-differentiated.The WHO histological classification and IASLC histologic grade were related to the patient’s gender,tumor size,vascular invasion,lymph node metastasis,STAS,pleural invasion,and pTNM staging of lung invasive adenocarcinoma.The receiver operating curve showed that the IASCL grading system was better than the WHO histological grading in predicting vascular invasion,lymph node metastasis,STAS,and pleural invasion,while the IASCL grading was worse than the WHO histological grading in the pTNM staging.Conclusion Compared with the WHO classification system,the IASLC grading system can better predict the clinical biological behavior of lung adenocarcinoma and should be recommended in clinical practice.