Koji Tsuta1, Mitsumasa Kawago2, Eisuke Inoue3, Akihiko Yoshida4, Fumiaki Takahashi3, Hiroyuki Sakurai5, Shun-Ichi Watanabe5, Masahiro Takeuchi3, Koh Furuta4, Hisao Asamura5, Hitoshi Tsuda4. 1. Division of Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan. Electronic address: ktsuta@ncc.go.jp. 2. Division of Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan. 3. Department of Clinical Medicine (Biostatistics), School of Pharmacy, Kitasato University, Tokyo, Japan. 4. Division of Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan. 5. Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Abstract
BACKGROUND: The present study aimed to determine the ability of the revised International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification of lung adenocarcinoma to predict patient survivals and driver gene alterations. PATIENTS AND METHODS: A reclassification of 904 surgically resected adenocarcinomas was performed. The results were statistically analyzed to examine the correlation between the classification and overall survival (OS) using Cox regression analyses, and integrated discrimination improvement (IDI) analyses. RESULTS: The 5-year OS rates for adenocarcinomas in situ (AIS) or minimally invasive adenocarcinoma (MIA) were 98%. Five-year OS rates of Lepidic-, acinar-, papillary-, micropapillary-, and solid-predominant adenocarcinomas was 93%, 67%, 74%, 62%, and 58%, respectively. The IDI estimates revealed that classification of ADC into the 7 subgroups had a higher estimated (0.0175) than did the combined histological grouping (AIS + MIA, lepidic + acinar + papillary, micropapillary + solid + others) (0.0111). Epidermal growth factor receptor mutations, KRAS gene mutations, and anaplastic lymphoma kinase gene alterations were statistically prevalent in papillary-predominant (P = 0.00001), invasive mucinous (P = 0.00001), and micropapillary- and acinar-predominant (P = 0.00001) adenocarcinomas, respectively. CONCLUSIONS: The new classification reflects disease prognosis, and was also associated with driver gene alterations.
BACKGROUND: The present study aimed to determine the ability of the revised International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification of lung adenocarcinoma to predict patient survivals and driver gene alterations. PATIENTS AND METHODS: A reclassification of 904 surgically resected adenocarcinomas was performed. The results were statistically analyzed to examine the correlation between the classification and overall survival (OS) using Cox regression analyses, and integrated discrimination improvement (IDI) analyses. RESULTS: The 5-year OS rates for adenocarcinomas in situ (AIS) or minimally invasive adenocarcinoma (MIA) were 98%. Five-year OS rates of Lepidic-, acinar-, papillary-, micropapillary-, and solid-predominant adenocarcinomas was 93%, 67%, 74%, 62%, and 58%, respectively. The IDI estimates revealed that classification of ADC into the 7 subgroups had a higher estimated (0.0175) than did the combined histological grouping (AIS + MIA, lepidic + acinar + papillary, micropapillary + solid + others) (0.0111). Epidermal growth factor receptor mutations, KRAS gene mutations, and anaplastic lymphoma kinase gene alterations were statistically prevalent in papillary-predominant (P = 0.00001), invasive mucinous (P = 0.00001), and micropapillary- and acinar-predominant (P = 0.00001) adenocarcinomas, respectively. CONCLUSIONS: The new classification reflects disease prognosis, and was also associated with driver gene alterations.
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