A grading system for invasive pulmonary adenocarcinoma: A proposal From the International Association for the Study of Lung Cancer Pathology Committee Journal Article
| Authors: | Moreira, A. L.; Ocampo, P. S. S.; Xia, Y.; Zhong, H.; Russell, P. A.; Minami, Y.; Cooper, W. A.; Yoshida, A.; Bubendorf, L.; Papotti, M.; Pelosi, G.; Lopez-Rios, F.; Kunitoki, K.; Ferrari-Light, D.; Sholl, L. M.; Beasley, M. B.; Borczuk, A.; Botling, J.; Brambilla, E.; Chen, G.; Chou, T. Y.; Chung, J. H.; Dacic, S.; Jain, D.; Hirsch, F. R.; Hwang, D.; Lantuejoul, S.; Lin, D.; Longshore, J. W.; Motoi, N.; Noguchi, M.; Poleri, C.; Rekhtman, N.; Tsao, M. S.; Thunnissen, E.; Travis, W. D.; Yatabe, Y.; Roden, A. C.; Daigneault, J. B.; Wistuba, I. I.; Kerr, K. M.; Pass, H.; Nicholson, A. G.; Mino-Kenudson, M. |
| Article Title: | A grading system for invasive pulmonary adenocarcinoma: A proposal From the International Association for the Study of Lung Cancer Pathology Committee |
| Abstract: | Introduction: A grading system for pulmonary adenocarcinoma has not been established. The International Association for the Study of Lung Cancer pathology panel evaluated a set of histologic criteria associated with prognosis aimed at establishing a grading system for invasive pulmonary adenocarcinoma. Methods: A multi-institutional study involving multiple cohorts of invasive pulmonary adenocarcinomas was conducted. A cohort of 284 stage I pulmonary adenocarcinomas was used as a training set to identify histologic features associated with patient outcomes (recurrence-free survival [RFS] and overall survival [OS]). Receiver operating characteristic curve analysis was used to select the best model, which was validated (n = 212) and tested (n = 300, including stage I–III) in independent cohorts. Reproducibility of the model was assessed using kappa statistics. Results: The best model (area under the receiver operating characteristic curve [AUC] = 0.749 for RFS and 0.787 for OS) was composed of a combination of predominant plus high-grade histologic pattern with a cutoff of 20% for the latter. The model consists of the following: grade 1, lepidic predominant tumor; grade 2, acinar or papillary predominant tumor, both with no or less than 20% of high-grade patterns; and grade 3, any tumor with 20% or more of high-grade patterns (solid, micropapillary, or complex gland). Similar results were seen in the validation (AUC = 0.732 for RFS and 0.787 for OS) and test cohorts (AUC = 0.690 for RFS and 0.743 for OS), confirming the predictive value of the model. Interobserver reproducibility revealed good agreement (k = 0.617). Conclusions: A grading system based on the predominant and high-grade patterns is practical and prognostic for invasive pulmonary adenocarcinoma. © 2020 International Association for the Study of Lung Cancer |
| Keywords: | adenocarcinoma; lung; model; prognosis; tumor grading |
| Journal Title: | Journal of Thoracic Oncology |
| Volume: | 15 |
| Issue: | 10 |
| ISSN: | 1556-0864 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-10-01 |
| Start Page: | 1599 |
| End Page: | 1610 |
| Language: | English |
| DOI: | 10.1016/j.jtho.2020.06.001 |
| PUBMED: | 32562873 |
| PROVIDER: | scopus |
| PMCID: | PMC8362286 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 November 2020 -- Source: Scopus |
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