Validation of the novel International Association for the Study of Lung Cancer grading system and prognostic value of filigree micropapillary and discohesive growth pattern in invasive pulmonary adenocarcinoma

Yuan Zhang; Yanjun Zhang; Yi Hu; Shu Zhang; Min Zhu; Bin Hu; Xiaojuan Guo; Jun Lu; Yuhui Zhang

doi:10.1016/j.lungcan.2022.11.022

Validation of the novel International Association for the Study of Lung Cancer grading system and prognostic value of filigree micropapillary and discohesive growth pattern in invasive pulmonary adenocarcinoma

Lung Cancer. 2023 Jan:175:79-87. doi: 10.1016/j.lungcan.2022.11.022. Epub 2022 Dec 5.

Authors

Yuan Zhang¹, Yanjun Zhang², Yi Hu¹, Shu Zhang¹, Min Zhu¹, Bin Hu³, Xiaojuan Guo⁴, Jun Lu⁵, Yuhui Zhang⁶

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
² Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
³ Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
⁴ Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
⁵ Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Electronic address: lujun0612@126.com.
⁶ Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao Yang Hospital, Capital Medical University, Beijing, China. Electronic address: zhangyhcy@163.com.

PMID: 36481678
DOI: 10.1016/j.lungcan.2022.11.022

Abstract

Introduction: The Pathology Committee of the International Association for the Study of Lung Cancer (IASLC) proposed a new histological grading system based on the combination of predominant and high-grade patterns in 2020.

Materials and methods: Pathological sections from 631 patients with stage I-III invasive lung adenocarcinoma were reviewed. We then determined the histological grade according to the new grading system and confirmed the pathological features that included the filigree micropapillary and discohesive growth pattern. Applying of the novel IASLC grading system in prognosis stratification was verified and the clinical significance of the pathological characteristics was explored.

Results: Cox multivariable analysis revealed that in the stage I-III invasive lung adenocarcinoma, the IASLC grading system was significantly associated with disease-free survival (DFS) [hazard ratio (HR) = 1.419; 95 % confidence interval (CI): 1.040-1.937; P = 0.027] and overall survival (OS) (HR = 1.899; 95 % CI: 1.168-3.087; P = 0.010). In patients with IASLC Grades 1 and 2, the simultaneous presence of filigree micropapillary and discohesive growth pattern was significantly correlated with DFS (HR = 1.899; 95 % CI:1.168-3.087; P = 0.010). However, the filigree micropapillary and discohesive growth pattern did not affect the OS (HR = 2.786; P = 0.317). The competitive risk model revealed that in the stage I cohort, the simultaneous presence of filigree micropapillary and discohesive growth pattern was a risk factor for recurrence and metastasis [sub- distribution HR (SHR) = 1.987; 95 %CI: 1.122-3.518; P = 0.019].

Conclusion: Our study verified that the new prognostic stratification system was an effective stratification tool. Filigree micropapillary and discohesive growth pattern may also be risk factors for DFS, postoperative recurrence and metastasis.

Keywords: Discohesive growth pattern; Filigree micropapillary; IASLC grading system; Lung adenocarcinoma; Prognosis.

MeSH terms

Adenocarcinoma of Lung* / pathology
Adenocarcinoma* / pathology
Humans
Lung Neoplasms* / pathology
Neoplasm Staging
Prognosis
Retrospective Studies