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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.
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Article info
Publication history
Accepted:
January 17,
2023
Received in revised form:
January 15,
2023
Received:
July 18,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: The authors have no conflicts of interest to declare.
Funding Statement: This study was supported by the Shanghai Pulmonary Hospital Research Fund (FK1943), Clinical Research Foundation of Shanghai Pulmonary Hospital (No. FK1937) and National Natural Science Foundation of China (No.82272766).
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Copyright
© 2023 Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer.
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