肺腺癌病理分级与肿瘤气道播散及脉管侵犯的相关性

The correlation between pathological grading of lung adenocarcinoma and tumor airway dissemination and vascular invasion

目的:探究新版肺腺癌分级系统与气道播散及脉管侵犯的相关性。方法:回顾性分析四川省肿瘤医院2021年行肺癌手术且经术后病理确认浸润性肺腺癌的患者,采集患者临床及病理信息,根据IASLC发布的新浸润性肺腺癌分级标准将患者分为3组,低分化组(III级)、中分化组(II级)、高分化组(I级)。分析患者术后临床病理特征及基因型与分级的关系。结果:单因素分析显示,低分化肿瘤与老龄、男性、实性结节、肺叶切除术和侵袭性特征(肿瘤大小、淋巴结转移、分期、气道播散、脉管浸润、胸膜浸润)相关。且与中高分化肿瘤具有显著性差异(P<0.05)。多因素分析显示肿瘤影像学特征、气道播散、脉管侵犯是独立因素。对行基因检测人群分析,EGFR突变在三组间无统计学意义(P>0.05)。余基因型无法评估与分级相关性。结论:低分化肿瘤与气道播散及脉管侵犯相关。

Objective:To investigate the correlation between the new version of lung adenocarcinoma grading system and spread through air spaceand vascular invasion.Methods:Patients who underwent lung cancer surgery and had invasive lung adenocarcinoma confirmed by postoperative pathology in Sichuan Cancer Hospital in 2021 were retrospectively analyzed,clinical and pathological information was collected,and patients were classified into 3 groups according to the new invasive lung adenocarcinoma grading criteria published by IASLC,the low differentiation group(grade III),the intermediate differentiation group(grade II),and the high differentiation group(grade I).The postoperative clinicopathological characteristics of patients and the relationship between genotype and grading were analyzed.Results:Univariate analysis showed that poorly differentiated tumors were associated with old age,male,solid nodules,lobectomy,and invasive features(tumor size,lymph node metastasis,stage,airway spread,vascular invasion,pleural invasion).There was significant difference between the tumor and middle and high differentiation(P<0.05).Multifactorial analysis showed that tumor imaging features,airway dissemination and vascular invasion were independent factors.Analysis of the population undergoing genetic testing showed that EGFR mutations were not statistically significant among the three groups(P>0.05).The remaining genotypes could not be assessed for correlation with grading.Conclusion:Airway dissemination and vascular invasion were associated with the new lung adenocarcinoma grade.