title: A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stage I tumors.
abstract: Currently no objective grading system for pulmonary adenocarcinomas exists. To determine whether specific histologic patterns or combinations thereof could be linked to an objective grading system, the histologic patterns in metastatic tumor deposits was compared with the patterns seen in the corresponding 73 primary tumor to determine whether a specific pattern had higher propensity to metastasize. The concordance of the predominant histologic pattern in the primary tumor and the metastases was of 100% for micropapillary, 86% for solid, 42% for acinar, and 23% for papillary types of adenocarcinoma. Informed by these results, a 3-tier grading system based on the histologic subtypes was established. Grade I, a pattern with low metastatic potential (BAC); Grade II, patterns with intermediate metastatic potential (acinar and papillary); and Grade III, patterns with high metastatic potential (solid and micropapillary). These grades were combined into a number of different scoring systems, whose ability to predict recurrence or death from disease was tested in 366 stage 1 adenocarcinomas. A score based on the 2 most predominant grades was able to stratify patients into low-to-high risk for recurrence or death of disease (P=0.001). The 5-years disease-free survival for patients in the highest score group was of 0.73, compared with 0.84 and 0.92 in the intermediate and lowest score groups. Concordance probability estimate was 0.65 (95% confidence interval 0.57-0.73). Therefore, this scoring system provides valuable information in discriminating patients with different risk of disease-recurrence in a highly homogeneous population of patients with stage I cancer.
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sica
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Camelia S
authors.initials: CS
authors.lastname: Sima
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Azzoli
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.forename: Andre L
authors.initials: AL
authors.lastname: Moreira
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009519:New York City; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome