Clinical implication of the 2020 International Association for the Study of Lung Cancer histologic grading in surgically resected pathologic stage 1 lung adenocarcinomas: Prognostic value and association with computed tomography characteristics

In Sung Cho; Hyo Sup Shim; Hye-Jeong Lee; Young Joo Suh

doi:10.1016/j.lungcan.2023.107345

Clinical implication of the 2020 International Association for the Study of Lung Cancer histologic grading in surgically resected pathologic stage 1 lung adenocarcinomas: Prognostic value and association with computed tomography characteristics

Lung Cancer. 2023 Oct:184:107345. doi: 10.1016/j.lungcan.2023.107345. Epub 2023 Aug 12.

Authors

In Sung Cho¹, Hyo Sup Shim², Hye-Jeong Lee¹, Young Joo Suh³

Affiliations

¹ Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: rongzusuh@gmail.com.

PMID: 37611496
DOI: 10.1016/j.lungcan.2023.107345

Abstract

Objectives: To investigate the incremental prognostic value of the 2020 International Association for the Study of Lung Cancer (IASLC) histologic grading system over traditional prognosticators in surgically resected pathologic stage 1 lung adenocarcinomas and to identify the clinical and radiologic characteristics of lung adenocarcinomas reclassified by the 2020 histologic grading system.

Materials and methods: We retrospectively enrolled 356 patients who underwent surgery for pathologic stage 1 adenocarcinoma between January 2016 and December 2017. The histologic grading was classified according to the predominant histologic subtype (conventional system) and the updated 2020 IASLC grading system. The clinical and computed tomography (CT) characteristics were compared according to the reclassification of the updated system. The performance of prognostic models for recurrence-free survival based on the combination of pathologic tumor size, histologic grade, and CT-based information was compared using the c-index.

Results: Postoperative recurrence occurred in 6.7% of patients during the follow-up period (mean, 1589.2 ± 406.7 days). Fifty-nine of 244 (24.2%) tumors with intermediate grades in the conventional system were reclassified as grade 3 with the updated grading system. They showed significantly larger solid proportions and higher percentages of pure solid nodules on CT compared to tumors without reclassification (n = 185) (P < 0.05). Prognostic prediction models based on pathology tumor size and histologic grades had significantly higher c-indices (0.754-0.803) compared to the model based on pathologic tumor size only (c-index:0.723, P < 0.05).

Conclusion: The 2020 IASLC histologic grading system has significant incremental prognostic value over the pathologic stage in surgically resected pathologic stage 1 lung adenocarcinoma. Reclassified lung adenocarcinomas using the updated grading system have a larger solid proportion and a higher percentage of pure solid nodules on CT.

Keywords: CT characteristics; Histologic subtype; Lung adenocarcinoma; Prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma of Lung* / diagnostic imaging
Adenocarcinoma of Lung* / surgery
Humans
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / surgery
Prognosis
Retrospective Studies
Tomography, X-Ray Computed