title: Proposal of a prognostically relevant grading scheme for pulmonary squamous cell carcinoma.
abstract: Recent studies in lung adenocarcinoma established a clinically relevant histomorphology-based classification. In contrast, no morphological classifiers have yet been implemented into routine diagnostics for lung squamous cell carcinoma (SQCC). However, morphology-based characteristics putatively impacting on survival have been proposed.We analysed a cohort of 541 SQCC patients with complete clinical follow-up data for morphological characteristics (keratinisation, tumour cell budding, size of tumour cell nests, nuclear size and stromal content). Morphological characteristics were correlated with clinical data and patient outcome.Keratinisation, budding, stromal content and tumour cell nest size, but not nuclear size, were associated with distinct clinicopathological characteristics and survival. SQCC patients with keratinisation, small cell nest size, high stromal content and extensive budding had shorter overall survival. A combined grading scheme composed of the two most reliable validated prognostic markers, i.e. budding and nest size, resulted in an age-, stage- and sex-independent prognosticator for overall survival with a hazard ratio of 1.6 for grade 2 tumours and a hazard ratio of 3.7 for grade 3 tumours when compared with grade 1 neoplasms (p<0.001).Morphological characteristics of SQCC have significant prognostic impact and could constitute the basis for a diagnostically relevant future SQCC grading scheme.
authors.affiliation: Institute of Pathology, Heidelberg University, Heidelberg, Germany National Center for Tumor Diseases (NCT), Heidelberg, Germany Institute of Pathology, Technical University Munich (TUM), Munich, Germany wilko.weichert@med.uni-heidelberg.de.
authors.forename: Wilko
authors.initials: W
authors.lastname: Weichert
authors.affiliation: Institute of Pathology, Heidelberg University, Heidelberg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kossakowski
authors.affiliation: Institute of Pathology, Heidelberg University, Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Harms
authors.affiliation: Institute of Pathology, Heidelberg University, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.affiliation: Translational Research Unit, Thoraxklinik at Heidelberg University, Heidelberg, Germany Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Muley
authors.affiliation: Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany Dept of Thoracic Surgery, Thoraxklinik at Heidelberg University, Heidelberg, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Dienemann
authors.affiliation: Institute of Pathology, Heidelberg University, Heidelberg, Germany Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Warth
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000473:pathology*; D005260:Female; D005858:Germany; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D011379:Prognosis