目的:肿瘤分级是促进患者管理的病理评估的重要组成部分。国际肺癌研究协会(IASLC)于2020年提出了非黏液性肺腺癌的分级系统。我们旨在基于文献数据验证这种新型分级系统对总生存期(OS)和无复发生存期(RFS)的预后影响。
结果:审查方案已在PROSPERO(CRD42023396059)中注册。我们旨在确定2020年后发表的比较Medline不同IASLC等级类别的随机或非随机对照试验,Embase,中央。合并OS和RFS的95%置信区间(CI)的危险比(HR),并使用预后研究质量(QUIPS)工具评估纳入研究的偏倚风险。有十篇文章有资格参加这次审查。关于操作系统估计,在单因素和多因素分析中,1级肺腺癌优于3级(HROSuni=0.19,95%CI:0.05-0.66,p=0.009;HROSmatic=0.21,95%CI:0.12-0.38,p<0.001)。关于RFS估计,在多变量分析中,3级腺癌的预后比1级差(HRRFSmulti:0.22,95%CI:0.14-0.35,p<0.001).
结论:文献数据和我们的荟萃分析结果证明了IASLC分级系统的预后相关性。这支持将该预后参数包含在全世界的日常生活中。
OBJECTIVE: Tumour grading is an essential part of the pathologic assessment that promotes patient management. The International Association for the Study of Lung Cancer (IASLC) proposed a grading system for non-mucinous lung adenocarcinoma in 2020. We aimed to validate the prognostic impact of this novel grading system on overall survival (OS) and recurrence-free survival (RFS) based on literature data.
RESULTS: The
review protocol was registered in PROSPERO (CRD42023396059). We aimed to identify randomized or non-randomized controlled trials published after 2020 comparing different IASLC grade categories in Medline, Embase, and CENTRAL. Hazard ratios (HRs) with 95% confidence intervals (CIs) of OS and RFS were pooled and the Quality In Prognosis Studies (QUIPS) tool was used to assess the risk of bias in the included studies. Ten articles were eligible for this
review. Regarding OS estimates, grade 1 lung adenocarcinomas were better than grade 3 both in univariate and multivariate analyses (HROSuni = 0.19, 95% CI: 0.05-0.66, p = 0.009; HROSmulti = 0.21, 95% CI: 0.12-0.38, p < 0.001). Regarding RFS estimates, grade 3 adenocarcinomas had a worse prognosis than grade 1 in multivariate analysis (HRRFSmulti: 0.22, 95% CI: 0.14-0.35, p < 0.001).
CONCLUSIONS: The literature data and the result of our meta-analysis demonstrate the prognostic relevance of the IASLC grading system. This supports the inclusion of this prognostic parameter in daily routine worldwide.