■最近的随机对照试验(JCOG0802和CALGB140503)显示,对于≤2.0cm的非小细胞肺癌(NSCLC),叶下切除术不低于肺叶切除术。我们先前提出了将肺腺癌分为惰性低恶性潜能(LMP)和侵袭性血管浸润性腺癌的组织学标准,导致比世界卫生组织等级提供的更好的预测。在这里,我们确定病理分类是否可重复,以及腺癌的亚群与肺叶切除术相比,楔形切除术治疗后的预后是否较差。
■从2个机构收集了108例楔形切除术和187例I/0期肺腺癌≤2.0cm肺叶切除术的患者的回顾性队列。所有肿瘤都由一位病理学家分类,5名病理学家在一个子集(n=92)中评估了观察者间的可重复性。
■与肺叶切除术相比,使用楔形切除术治疗时,血管浸润性腺癌(占病例的21%-27%)的预后较差(5年无复发生存率,57%vs85%[P=.007];5年无病生存率[DSS],70%vs90%[P=.043];7年总生存率,37%对58%[P=.143])。原位腺癌(AIS),微创腺癌(MIA),无论手术方式如何,LMP均表现出100%的5年DSS。多变量分析表明,血管浸润,肿瘤大小,边距状态,淋巴结采样的程度与复发显著相关,但与外科手术无关.病理学家在诊断血管浸润性腺癌(κ=0.71)和合并的惰性AIS/MIA/LMP组(κ=0.74)中具有相当的观察者间可重复性。
■大多数(约75%)≤2厘米的肺腺癌可以通过楔形切除术得到充分治疗;然而,通过楔形切除术与次优淋巴结取样治疗的血管浸润性腺癌(~25%)表现出较差的结果,5年内复发率为40%至45%,7年时总死亡率为60%至65%。
UNASSIGNED: Recent randomized control trials (JCOG0802 and CALGB140503) have shown sublobar resection to be noninferior to lobectomy for non-small cell lung cancer (NSCLC) ≤2.0 cm. We have previously proposed histologic criteria stratifying lung adenocarcinoma into indolent low malignant potential (LMP) and aggressive
angioinvasive adenocarcinomas, resulting in better prognostication than provided by World Health Organization grade. Here we determine whether pathologic classification is reproducible and whether subsets of adenocarcinomas predict worse outcomes when treated by wedge resection compared to lobectomy.
UNASSIGNED: A retrospective cohort of 108 recipients of wedge resection and 187 recipients of lobectomy for stage I/0 lung adenocarcinomas ≤2.0 cm was assembled from 2 institutions. All tumors were classified by a single pathologist, and interobserver reproducibility was assessed in a subset (n = 92) by 5 pathologists.
UNASSIGNED: Angioinvasive adenocarcinoma (21%-27% of cases) was associated with worse outcomes when treated with wedge resection compared to lobectomy (5-year recurrence-free survival, 57% vs 85% [P = .007]; 5-year disease-free survival [DSS], 70% vs 90% [P = .043]; 7-year overall survival, 37% vs 58% [P = .143]). Adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and LMP exhibited 100% 5-year DSS regardless of the surgical approach. Multivariable analysis showed that angioinvasion, tumor size, margin status, and extent of nodal sampling were significantly associated with recurrence but not with surgical procedure. There was substantial interobserver reproducibility among the pathologists for the diagnosis of
angioinvasive adenocarcinoma (κ = 0.71) and the combined indolent AIS/MIA/LMP group (κ = 0.74).
UNASSIGNED: The majority (∼75%) of lung adenocarcinomas ≤2 cm are adequately managed with wedge resection; however,
angioinvasive adenocarcinomas (∼25%) treated by wedge resection with suboptimal nodal sampling exhibit poor outcomes, with a 40% to 45% rate of recurrence within 5 years and 60% to 65% overall mortality at 7 years.