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Discohesive growth pattern (Disco-p) as an unfavorable prognostic factor in lung adenocarcinoma: an analysis of 1062 Japanese patients with resected lung adenocarcinoma

Kurata, Mariyo 京都大学 DOI:10.14989/doctor.k24186

2022.09.26

概要

肺腺癌は5つの主要な組織学的パターン(置換型、腺房型、乳頭型、微小乳頭型、充実型)に分類され、そのパターンを利用してグレード分類が行われている。この主要な5パターンの他、非結合性増殖パターン(Disco hesive growth pattern, Disco-p)は、肺腺癌でもしばしば観察され、腫瘍の簇出(tumor budding, TB)、間質浸潤型微小乳糖パターン(stromal invasive-type micro papillary pattern, SMPP)、および複雑腺パターン(complex glandular pattern, CGP)に類似している。肺腺癌におけるDisco-pの臨床的意義については十分に検討されていない。この研究ではDisco-pが予後に与える影響を調べるために、Disco-pと臨床病理学的特徴を検討した。

2001年から2015年までに京都大学医学部附属病院で手術された原発性肺腺癌の切除症例のうち、多発症例、術前治療症例、不完全切除例、フォローアップ情報が欠けている症例を除く1062例を対象とした。Disco-pは病理組織学的に、線維性間質を背景とした個細胞性、小胞巣状、索状浸潤パターンと定義した。Disco-pの割合は、主要な組織学的パターンとは無関係に5%刻みで記録し、様々な臨床病理学的因子との相関を検討した。また、全生存期間(OS)および無病生存期間(DFS)の解析も行った。

Disco-pは203例の症例で観察された(19.1%)。Disco-pは男性、喫煙、リンパ節転移、大きな腫瘍径、進行病期、リンパ管侵襲、胸膜浸潤、STAS(spread through air spaces)、TBと有意に関連していた(すべてp

Disco-pは肺腺癌切除患者における独立した予後不良因子であったが、類似のパターンと区別するために慎重な評価が必要である。Disco-pは新たな浸潤パターンとして認識され、肺腺癌患者のより良い管理のために正確に記録されるべきであることを提案する。

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