冰冻切片准确预测IASLC提出的分级系统和浸润性肺腺癌患者的预后

SCI 27 March 2023

Frozen Sections Accurately Predict the IASLC Proposed Grading System and Prognosis in Patients with Invasive Lung Adenocarcinomas

(IF: LUNG CANCER, 6.081)

J. Fan, J. Yao, H. Si, H. Xie, T. Ge, W. Ye, J. Chen, Z. Yin, F. Zhuang, L. Xu, H. Su, S. Zhao, X. Xie, D. Zhao, C. Wu, Y. Zhu, Y. Ren, N. Xu, C. Chen, on behalf of the Surgical Thoracic Alliance of Rising Star Group, Frozen Sections Accurately Predict the IASLC Proposed Grading System and Prognosis in Patients with Invasive Lung Adenocarcinomas, Lung Cancer (2023)

Correspondence:Chang Chen

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China, E-mail: chenthoracic@163.com;

Ning Xu

Department of Thoracic Surgery, Anhui Chest Hospital, No. 397 Jixi Road, Shushan District, Hefei, 230022, People's Republic of China. E-mail: NingXuHefei@163.com;

Yijiu Ren

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Yangpu District, Shanghai, 200433, People's Republic of China, E-mail: ryjscott@hotmail.com

Introduction 介绍

The International Association for the Study of Lung Cancer (IASLC) newly proposed grading system for lung adenocarcinomas (ADC) has been shown to be of prognostic significance. Hence, intraoperative consultation for the grading system was important regarding the surgical decision-making. Here, we evaluated the accuracy and interobserver agreement for IASLC grading system on frozen section (FS), and further investigated the prognostic performance.

国际肺癌研究协会（IASLC）新提出的肺腺癌分级系统（ADC）已被证明具有指导预后的意义。因此，分级系统的术中咨询对于手术决策非常重要。在此，我们评估了冰冻切片（FS）IASLC分级系统的准确性和观察者间一致性，并进一步研究了预后表现。

Methods方法

FS and final pathology (FP) slides were reviewed by three pathologists for tumor grading in 373 stage I lung ADC following surgical resection from January to June 2013 (retrospective cohort). A prospective multicenter cohort (January to June 2021, n = 212) were included to confirm the results.

2013年1月至6月，三名病理学家对373例I期肺ADC手术切除后的FS和最终病理学（FP）切片进行了肿瘤分级审查（回顾性队列）。纳入了前瞻性多中心队列（2021年1月至6月，n=212）以确认结果。

Results 结果  

The overall concordance rates between FS and FP were 79.1% (κ = 0.650) and 89.6% (κ = 0.729) with substantial agreement in retrospective and prospective cohorts, respectively. Presence of complex gland was the only independent predictor of discrepancy between FS and FP (presence versus. absence: odds ratio, 2.193; P = 0.015). The interobserver agreement for IASLC grading system on FS among three pathologists were satisfactory (κ = 0.672 for retrospective cohort; κ = 0.752 for prospective cohort). Moreover, the IASLC grading system by FS diagnosis could well predict recurrence-free survival and overall survival for patients with stage I invasive lung ADC.

FS和FP的总体一致性分别为79.1%（κ=0.650）和89.6%（κ=0.729），在回顾性和前瞻性队列中基本一致。复杂腺体的存在是FS和FP之间差异的唯一独立预测因子（存在与否：比值比，2.193；P=0.015）。三名病理学家对IASLC FS分级系统的观察者间一致性令人满意（回顾性队列κ=0.672；前瞻性队列κ=0.752）。此外，通过FS诊断的IASLC分级系统可以很好地预测I期浸润性肺ADC患者的无复发生存率和总生存率。

Conclusions 结论  

Our results suggest that FS had high diagnostic accuracy and satisfactory interobserver agreement for IASLC grading system. Future prospective studies are merited to validate the feasibility of using FS to match patients into appropriate surgical type.

我们的结果表明，FS对IASLC分级系统具有较高的诊断准确性和令人满意的观察者间一致性。未来的前瞻性研究值得验证使用FS将患者匹配到适当手术类型的可行性。