WHO(2021)浸润性肺腺癌新分级在447例Ⅰ期肺腺癌临床病理特征、预后相关性的应用

Clinicopathological characteristics and prognostic correlation of stage Ⅰ pulmonaryadenocarcinoma: analysis of 447 cases of invasive pulmonaryadenocarcinoma by using WHO new grading system (2021)

目的 探讨WHO(2021)浸润性肺腺癌新分级在Ⅰ期肺腺癌临床病理特征、预后相关性的应用分析。方法 收集447例Ⅰ期肺腺癌患者的临床资料,按WHO(2021)浸润性肺腺癌新分级标准将病例评估入组。采用免疫组化EnVision两步法和弹力纤维染色进行检测,分析其临床病理特征并复习相关文献。结果 447例Ⅰ期肺腺癌中Napsin A、TTF-1均阳性,p40均阴性,Ki-67增殖指数>5%(177例,39.6%)。弹力纤维染色脏层胸膜侵犯阳性39例(8.7%),Ⅰ期肺腺癌患者胸膜侵犯在2、3级中明显高于1级,差异有统计学意义(P<0.05)。不同分级的Ⅰ期肺腺癌与患者性别、吸烟史、手术方式、化疗、靶向用药、临床分期、病理分型、分化程度、肿瘤大小、脉管侵犯、沿气腔播散、Ki-67增殖指数,差异均有统计学意义(P<0.001)。生存分析显示:不同分级的患者无瘤生存期和总生存期差异均有统计学意义,且1级>2级>3级(P<0.05)。Cox回归分析显示:WHO(2021)浸润性肺腺癌新分级、脏层胸膜侵犯、Ki-67增殖指数是Ⅰ期肺腺癌患者预后的独立危险因素。结论 WHO(2021)浸润性肺腺癌新分级对Ⅰ期肺腺癌患者预后有较好的预测意义,给予高危患者合适的干预,能够有效辅助其术后治疗。

Purpose To investigate the clinicopathological characteristics and prognostic correlation of the WHO(2021)new grading system of invasive pulmonary adenocarcinoma in stage Ⅰ pulmonary adenocarcinoma. Methods The clinical data of 447 patients with stage I pulmonary adenocarcinoma were collected, and all cases were evaluated according to the new grading system for invasive pulmonary adenocarcinoma. The immunohistochemical EnVision two-step method and elastic fiber staining were used to analyze the clinicopathological features with review of the relevant literature. Results In 447 patients with stage I lung adenocarcinoma, Napsin A and TTF-1 expression were positive, p40 expression was negative, and Ki-67 proliferation index was higher than 5% in 177 patients (39.6%). There were 39 cases (8.7%) of positive pleural invasion in the visceral layer revealed by elastic fiber staining. The pleural invasion in stage I pulmonary adenocarcinoma patients was significantly higher than that in grades 2 and 3, the difference was statistically significant ( P <0.05). Patients with different grades of stage Ⅰ pulmonary adenocarcinoma were associated with gender, smoking history, surgical mode, chemotherapy, targeted medication, clinical stage, pathological classification, degree of differentiation, tumor size, vascular invasion, visceral pleural invasion, spread through air space (STAS) and Ki-67 index ( P <0.05). Survival analysis showed that there were statistically significant differences in disease free survival (DFS) and overall survival (OS) among different grades (grade 1 > grade 2 > grade 3) ( P <0.05). Cox regression analysis showed that WHO (2021) new grading of invasive pulmonary adenocarcinoma, visceral pleural invasion and Ki-67 proliferation index were independent risk factors for prognosis of patients with stage I pulmonary adenocarcinoma. Conclusion The WHO (2021) new grading system of invasive pulmonary adenocarcinoma has good prognostic significance for stage Ⅰ pulmonary adenocarcinoma, and appropriate intervention for high-risk patients. It can effectively assist its postoperative treatment and has application value.