Predictive Value of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma in Tumor Recurrence and Patient Survival

Hung, Jan Jong; Yeh, Yi Chen; Jeng, Wen Juei; Wu, Kou Juey; Huang, Bin; Wu, Yu Chung; Chou, Teh Ying; Hsu, Wen Hu

doi:10.1200/jco.2013.50.1049

Cited by 207 publications

(140 citation statements)

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“…The pathologic heterogeneity index was calculated from each tumor to evaluate the degree of pathologic heterogeneity, which was confirmed to reflect the survival predictive value according to the proportion of mixed histologic subtypes that were derived from the hazard ratio (HR) of each subtype using the disease-free survival curve of a large-scale study [4]. Further details about the pathologic heterogeneity index are described in the supplement.…”

Section: Methodsmentioning

confidence: 99%

“…This classification was devised to understand the histological subtypes and their histo-molecular correlations. Since the release of this classification, many studies have investigated the possible correlations among the most predominant subtypes, driver mutations and patient prognosis [4, 5]. However, prognostic stratification considering only the most predominant subtypes has shown substantial limitation due to the fact that more than 80% of invasive lung adenocarcinomas show mixed type including two or more of histologic subtypes [6–9].…”

Section: Introductionmentioning

confidence: 99%

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Quantitative image variables reflect the intratumoral pathologic heterogeneity of lung adenocarcinoma

et al. 2016

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We aimed to compare quantitative radiomic parameters from dual-energy computed tomography (DECT) of lung adenocarcinoma and pathologic complexity.A total 89 tumors with clinical stage I/II lung adenocarcinoma were prospectively included. Fifty one radiomic features were assessed both from iodine images and non-contrast images of DECT datasets. Comprehensive histologic subtyping was evaluated with all surgically resected tumors. The degree of pathologic heterogeneity was assessed using pathologic index and the number of mixture histologic subtypes in a tumor. Radiomic parameters were correlated with pathologic index. Tumors were classified as three groups according to the number of mixture histologic subtypes and radiomic parameters were compared between the three groups.Tumor density and 50th through 97.5th percentile Hounsfield units (HU) of histogram on non-contrast images showed strong correlation with the pathologic heterogeneity. Radiomic parameters including 75th and 97.5th percentile HU of histogram, entropy, and inertia on 1-, 2- and 3 voxel distance on non-contrast images showed incremental changes while homogeneity showed detrimental change according to the number of mixture histologic subtypes (all Ps < 0.05).Radiomic variables from DECT of lung adenocarcinoma reflect pathologic intratumoral heterogeneity, which may help in the prediction of intratumoral heterogeneity of the whole tumor.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative image variables reflect the intratumoral pathologic heterogeneity of lung adenocarcinoma

et al. 2016

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“…3-21 Seventeen studies demonstrated significant differences in patient outcomes among the histologic subtypes 3-12, 14, 15, 17-21 while only 2 studies did not. 13, 16 The survival rate for predominant histological subtypes and the outcome and the distribution of each histological subtypes is outlined in Figure 3 .…”

Section: Introductionmentioning

confidence: 99%

“…They reported that MIP and SOL predominant subgroups were significantly associated with lymph node metastases at the resection site and that they were a significant association with aggressive postoperative behavior that favors early distant metastasis. 17 Zhang et al concluded in their retrospective study of 243 patients with resected NSCLC that tumor size was not a reliable predictor of the N0 status and that histologic subtyping might be useful in avoiding systematic lymph node dissection in more than one-third of small (≤ 2 cm) NSCLC. 43 In our retrospective study, we identified that the presence of MIP pattern and absence of LEP pattern was significantly associated with occult mediastinal lymph node metastasis in patients with clinically diagnosed N0/N1 lung adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

The New IASLC-ATS-ERS Lung Adenocarcinoma Classification: What the Surgeon Should Know

Eguchi

Kadota

Park

et al. 2014

Seminars in Thoracic and Cardiovascular Surgery

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In 2011, a new histologic classification of lung adenocarcinomas was proposed from a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), based on the recommendation of an international and multidisciplinary panel. This classification proposed a method of comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary, and solid pattern) based on semi-quantitative assessment of histologic patterns (in 5% increments) with the ultimate goal of choosing a single, predominant pattern. Prognostic subsets could then be described for the classification. Patients with completely resected adenocarcinomas in situ (AIS) and minimally invasive adenocarcinomas (MIA) experienced low risk of recurrence. Patients with micropapillary or solid predominant tumors have a high risk for recurrence or cancer-related death. Patients with acinar and papillary predominant tumors comprise an intermediate-risk group. Herein, we review the outline of the proposed IASLC/ATS/ERS classification, a summary of published validation studies of this new classification and then discuss surgical key issues; we mainly focused on limited resection as an adequate treatment for early-stage lung adenocarcinomas as well as pre- and intraoperative diagnoses. We also review the published studies that identified the importance of histological subtypes in predicting recurrence, both rates and patterns, in early-stage lung adenocarcinomas. This new classification for the most common type of lung cancer is useful for surgeons, as its implementation would require only hematoxylin and eosin (H&E) histology slides, which is the common type of stain used in hospitals. It can be implemented with routine pathology evaluation and with no additional costs.

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“…Moreover, applying the most predominant subtype concept means that other minor yet important components may be excluded from consideration. In this context, we aimed to determine the relative prognostic significance of each subtype from a development cohort using data from a large study group [9]. Furthermore, we attempted to establish a pathologic index based on the relative prognostic significance of each subtype that accurately reflects the pathologic subtypes and overall heterogeneity of lung adenocarcinomas.…”

Section: Introductionmentioning

confidence: 99%

Pathologic heterogeneity of lung adenocarcinomas: A novel pathologic index predicts survival

et al. 2016

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Although the most predominant subtype of invasive lung adenocarcinoma has been reported to have clinical significance, a major limitation of this concept is that most tumors are mixed-subtype. Therefore, we aimed to determine the individual prognostic significance of each subtype and also attempted to establish a pathologic index that reflects the pathologic subtypes and overall heterogeneity of lung adenocarcinomas and evaluated its prognostic significance. The individual prognostic impact of each subtype was assessed from the development cohort using the disease-free survival (DFS) curve of a previous large-scale study. Hazard ratios (HRs) from the development cohort were 1, 1.025, 1.059, 1.495, and 1.160 for the lepidic, acinar, papillary, micropapillary, and solid pattern subtype, respectively. Based on the calculated HR of each subtype, four indices representing pathologic heterogeneity were developed. The first and second indices were defined as the sum of the proportions of each subtype multiplied by their HRs, with the addition of either entropy or Gini coefficient, respectively. The third index was calculated as the sum of all subtype percentages multiplied by their HRs. To emphasize heterogeneity, the fourth index was defined as the simple arithmetic sum of the scores of the subtypes multiplied by their HRs. Each subtype was assigned a score of 0 if the subtype was absent and a score of 1 if the subtype was present in a binary fashion. We applied these four pathologic indices to a validation group of 148 patients with comprehensive histologic subtyping for completely resected lung adenocarcinomas. DFS curves were plotted and predictive ability of each pathologic index was evaluated. Among the four pathologic indices, only pathologic index 3 enabled significant patient stratification in the validation cohort according to DFS (P = 0.004) and showed the highest Harrell's C index of 0.691 of all four pathologic indices. In conclusion, we estimated the HR of each subtype and generated four pathologic indices that reflect heterogeneity. One of these, index 3, the pathologic heterogeneity index based on the sum of all subtype percentages multiplied by their HR, possesses good prognostic ability for predicting survival in patients with lung adenocarcinoma.

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Predictive Value of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma in Tumor Recurrence and Patient Survival

Cited by 207 publications

References 31 publications

Quantitative image variables reflect the intratumoral pathologic heterogeneity of lung adenocarcinoma

Quantitative image variables reflect the intratumoral pathologic heterogeneity of lung adenocarcinoma

The New IASLC-ATS-ERS Lung Adenocarcinoma Classification: What the Surgeon Should Know

Pathologic heterogeneity of lung adenocarcinomas: A novel pathologic index predicts survival

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