将浸润性黏液腺癌纳入IASLC肺腺癌分级系统的回顾性队列研究

A retrospective cohort study integrating invasive mucinous adenocarcinoma into the IASLC grading system for lung adenocarcinoma.

期刊: Translational Lung Cancer Research
PMID: 42582775
原文: PubMed ↗
发布日期: 2026-08-12

作者

Hanyue Li — Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Haoran Liu — Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Hui Shi — Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Rongji Mu — Institute of Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Lei Xu — Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Wentao Fang — Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Teng Mao — Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

作者单位

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Institute of Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

摘要

中文

目前的国际肺癌研究协会（IASLC）肺浸润性腺癌分级系统排除了浸润性黏液腺癌（IMA）和混合性IMA，限制了其预后判断的适用范围。我们旨在通过纳入IMA和混合性IMA来完善IASLC分级系统，并在大规模队列中加以验证。这项单机构研究纳入了来自上海胸科医院的692例I-III期肺浸润性腺癌患者（训练队列）以及来自监测、流行病学与最终结果（SEER）数据库的7,862例患者（验证队列）。我们引入IMA并重新划分了IASLC分级系统。使用Harrell C指数、时间依赖性受试者工作特征（ROC）曲线和曲线下面积（AUC）评估预后性能。采用Kaplan-Meier法估计总生存期（OS）曲线，并用log-rank检验比较差异。以黏液成分为主且高级别模式（实性、微乳头、复杂腺体模式）<20%的肿瘤被划分为2级（中分化）。所提出的扩展分级系统显示出更高的预后准确性，训练队列的C指数和AUC分别为0.713和0.739，验证队列分别为0.707和0.742。训练队列中1级、2级和3级的5年OS率分别为87.5%、73.1%和55.5%（P<0.001），验证队列分别为80.2%、67.3%和60.0%（P<0.001）。在两个队列中，所提出的扩展分级系统与现行IASLC分级系统相比均表现出更优的预后性能。所提出的扩展IASLC分级系统对肺浸润性腺癌具有实用性和预后价值，引入IMA可提高其适用性。

English

The current International Association for the Study of Lung Cancer (IASLC) grading system for invasive pulmonary adenocarcinoma excludes invasive mucinous adenocarcinoma (IMA) and mixed IMA, limiting its prognostic scope. We aimed to refine the IASLC grading system by incorporating IMA and mixed IMA, and to validate it in large-scale cohorts. This single-institutional study included 692 patients with stage I-III lung invasive adenocarcinoma from Shanghai Chest Hospital (training cohort) and 7,862 from the Surveillance, Epidemiology, and End Results (SEER) database (validation cohort). We introduced IMA and reclassified the IASLC grading system. Prognostic performance was assessed using Harrell C-index, time-dependent receiver operating characteristic (ROC) curves and areas under the curve (AUCs). Overall survival (OS) curves were estimated via the Kaplan-Meier method, with log-rank test for difference comparison. Mucinous predominant tumors with <20% of high-grade patterns (solid, micro papillary, complex glandular patterns) were classified as the Grade 2 (moderately differentiated). The proposed expanded grading system demonstrated improved prognostic accuracy, with C-index and AUC values of 0.713 and 0.739 in the training cohort, and 0.707 and 0.742 in the validation cohort, respectively. The 5-year OS rates for Grade 1, Grade 2, and Grade 3 were 87.5%, 73.1%, and 55.5% in the training cohort (P<0.001), and 80.2%, 67.3%, and 60.0% in the validation cohort (P<0.001). The proposed expanded grading system demonstrated superior prognostic performance compared to the current IASLC grading system in both cohorts. The proposed expanded IASLC grading system was practical and prognostic for lung invasive adenocarcinoma, and the introduction of IMA could improve its applicability.

分类与指标

研究类型: 临床研究
病种: 肺癌
JCR 分区: Q2
影响因子: 3.4
新锐分区: 3区