title: The prognostic value of morphologic findings for lung squamous cell carcinoma patients.
abstract: BACKGROUND
  Novel histopathological prognostic features for squamous cell carcinoma (SCC) of lung, such as tumor budding, mitotic rate, tumor stroma ratio, stroma type, stromal inflammation and necrosis, have been evaluated in the literature. In this study, the prognostic value of multiple morphological features is assessed in lung SCC.
  
  
  METHODS
  This study reports on seventy-six patients with lung SCC treated with complete surgical excision. Tumor size, tumor stage, lymph node status, lymphovascular invasion, histopathologic grade, mitotic count, necrosis, tumor budding, tumor stroma ratio, stroma type, stromal lymphoplasmacytic reaction and ratios of stromal plasma cells and their relationship with the prognosis were evaluated. Univariate and multivariate analyses were performed for histopathological markers for local disease free survival (LDFS), distant disease free survival (DDFS), overall disease free survival (ODFS) and overall survival (OS).
  
  
  RESULTS
  The univariate prognostic analysis of the pathological factors revealed that the pathological stage (OS: p=0.001, DDFS: p=0.040), lymph node metastases (OS: p=0.013), mitotic index (OS: p=0.026), tumor necrosis (DDFS: p=0.013, ODFS: p=0.021) and tumor size (OS: p=0.002) had a prognostic significance. The multivariate analysis demonstrated that the pathological stage (OS: p=0.021), tumor size (OS: p=0.044), lymph node status (DDFS: p=0.019, ODFS; p=0.041) and necrosis (ODFS: p=0.048) were independent prognostic factors.
  
  
  CONCLUSIONS
  Although many histopathological factors have recently been proposed as important prognostic markers, we only found significant results for mitotic index and tumor necrosis, as well as the well known parameters such as tumor stage and lymph node status. To the best of our knowledge, this is the first study evaluating such a wide range of morphological prognostic factors in lung SCC.
authors.affiliation: Department of Pathology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: duygu.gurel@deu.edu.tr.
authors.forename: Duygu
authors.initials: D
authors.lastname: Gürel
authors.affiliation: Department of Pathology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: cagnur.ulukus@deu.edu.tr.
authors.forename: Çağnur
authors.initials: Ç
authors.lastname: Ulukuş
authors.affiliation: Department of Thoracic Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: volkan.karacam@deu.edu.tr.
authors.forename: Volkan
authors.initials: V
authors.lastname: Karaçam
authors.affiliation: Institute of Oncology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: hulya.ellidokuz@deu.edu.tr.
authors.forename: Hülya
authors.initials: H
authors.lastname: Ellidokuz
authors.affiliation: Department of Radiation Oncology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: cenk.umay@deu.edu.tr.
authors.forename: Cenk
authors.initials: C
authors.lastname: Umay
authors.affiliation: Institute of Oncology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: ilhan.oztop@deu.edu.tr.
authors.forename: İlhan
authors.initials: İ
authors.lastname: Öztop
authors.affiliation: Department of Pathology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. Electronic address: sulen.sarioglu@deu.edu.tr.
authors.forename: Sülen
authors.initials: S
authors.lastname: Sarıoğlu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor
keywords: Lung cancer; Mitotic index; Necrosis; Prognosis; Tumor budding