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Application of the Novel Grading System of Invasive Pulmonary Adenocarcinoma in a Real Diagnostic Scenario: A Brief Report of 9353 Cases

  • Author Footnotes
    # These authors contributed equally to this work.
    Yunlang She
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Yifan Zhong
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Author Footnotes
    ∗ These authors are co-senior authors
    Likun Hou
    Footnotes
    ∗ These authors are co-senior authors
    Affiliations
    Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Shengnan Zhao
    Affiliations
    Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Liping Zhang
    Affiliations
    Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Dong Xie
    Affiliations
    Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Yuming Zhu
    Affiliations
    Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Chunyan Wu
    Affiliations
    Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
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  • Author Footnotes
    ∗ These authors are co-senior authors
    Chang Chen
    Correspondence
    Correspondence Author: Chang Chen, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200443, China,
    Footnotes
    ∗ These authors are co-senior authors
    Affiliations
    Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
    ∗ These authors are co-senior authors
Open AccessPublished:January 24, 2023DOI:https://doi.org/10.1016/j.jtocrr.2023.100465
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      Abstract

      Background

      The International Association for the Study of Lung Cancer proposed a novel grading system of invasive pulmonary adenocarcinoma (IPA), but the application of this grading system and its genotypic characterization in the real diagnostic scenario have never been reported.

      Material and Methods

      We prospectively collected and analyzed the clinicopathological and genotypic features of a cohort of 9353 consecutive patients with resected IPA, including 7134 patients with a detection of common driver mutation.

      Results

      In the entire cohort, 3 (0.3%) of lepidic, 1207 (19.0%) of acinar, and 126 (23.6%) of papillary predominant IPAs were diagnosed as grade 3. In chronological order, an evident downtrend of the proportion of grade 2 was observed in chronological order; conversely, the diagnostic ratio of grade 1 (8.0% to 14.5%) and grade 3 (27.9% to 32.3%) experienced a gradual rise. EGFR mutation was more frequently detected in grade 2 (77.5%) and grade 1 (69.7%) IPA than grade 3 (53.7%, p<0.001), while the mutation rates of KRAS, BRAF, ALK, and ROS1 were higher in grade 3 IPA. Importantly, the rate of EGFR mutation gradually fell as the proportion of high-grade components increased, to 24.3% in IPA with more than 90% high-grade components.

      Conclusions

      The grading system for IPA could be applied to stratify patients with different clinicopathological and genotypic features in a real diagnostic scenario.

      Key words