4.6 Article

Histological Scoring for Small Lung Adenocarcinomas 2 cm or Less in Diameter A Reliable Prognostic Indicator

Journal

JOURNAL OF THORACIC ONCOLOGY
Volume 5, Issue 3, Pages 333-339

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1097/JTO.0b013e3181c8cb95

Keywords

Small adenocarcinoma; Lung; Vessel invasion; Non-BAC size; %solid/cribriform/papillary; Scoring

Funding

  1. Ministry of Health, Labor and Welfare [16-1]

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Objective: Lung adenocarcinomas 2 cm or less in diameter were studied to develop histologic criteria predicting the outcome. Materials and Methods: We reviewed 510 consecutive lung adenocarcinomas 2 cm or less in diameter and assessed three histologic parameters to implement a histologic scoring system: lymphovascular invasion, maximum diameter of the nonbronchioloalveolar carcinoma (BAC) component, and percentage of the solid, cribriform, and/or papillary component in the entire tumor volume (%solid/cribriform/papillary). One point was given to each of lymphovascular invasion-positive, non-BAC > 10 mm and %solid/cribriform/papillary >= 30%, and by the sum of these points, a score of 0 to 3 was assigned for each tumor. We also evaluated minimally invasive adenocarcinomas comprising non-BAC <= 5 mm, Sakurai grades 1 and 2. Results: Five-year disease-free survival rates of 287 patients with a histologic score of 0, 69 with a score of 1, 64 with a score of 2, and 90 with a score of 3 were 98.9%, 92.4%, 78.4%, and 54.0%, respectively. The 510 tumors included 129 noninvasive and 127 minimally invasive adenocarcinomas. None of these tumors recurred. In remaining 254 patients with overtly invasive adenocarcinomas, 5-year disease-free survival rates in 51 with a histologic score of 0, 49 with a score of 1, 64 with a score of 2, and 90 with a score of 3 were 95.9%, 89.2%, 79.4%, and 54.2%, respectively. Conclusion: The histologic scoring system comprising lymphovascular invasion-positive, non-BAC > 10 mm and %solid/cribriform/papillary >= 30% is able to predict the outcome of lung adenocarcinomas 2 cm or less in diameter not only in all cases but also in overtly invasive adenocarcinomas. Minimally invasive adenocarcinomas did not recur in this large series.

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