title: Proposal of an improved histological sub-typing system for lung adenocarcinoma - significant prognostic values for stage I disease.
abstract: We have established a concise sub-typing system suitable for predicting the postoperative outcome in cases of stage I lung adenocarcinoma (ADC), using morphometric profiling. The association between postoperative disease recurrence and a variety of morphological features including histological architecture, cell type, cytoplasmic color/internal structure, nuclear shape/size, chromatin pattern, and nucleoli count/remarkableness, was analyzed. Histological architecture had the most prognostic value and could be subdivided into low-grade (bronchioloalveolar, papillary and tubular: "tubular" in this paper is defined as a tubular or glandular structure lined with single-layered neoplastic cells) and high-grade (acinar and solid: "acinar" is defined as a tubular or glandular structure lined with poly-layered neoplastic cells or as a fused glandular structure such as the cribriform pattern) components. The subgroups separated based on a cut-off value, 71.5% of the high-grade component comprised by a tumor, which was calculated according to a relative operating characteristic curve, exhibited a significant difference in disease recurrence [estimated 5-year disease-free survival rate, 95.3% in the low-grade group versus 66.7% in the high-grade group, hazard ratio 7.35, Log-rank test p = 0.002]. The sub-grouping system is concise and suitable for practical use. It will improve the histological classification of ADC.
authors.affiliation: Department of Pathology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Okudela
authors.forename: Tetsukan
authors.initials: T
authors.lastname: Woo
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mitsui
authors.forename: Takuya
authors.initials: T
authors.lastname: Yazawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimoyamada
authors.forename: Michihiko
authors.initials: M
authors.lastname: Tajiri
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ogawa
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kitamura
mesh_terms: D000230:Adenocarcinoma / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis