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The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society grading system has limited prognostic significance in advanced resected pulmonary adenocarcinoma

Westaway, Darin D.*,¶; Toon, Christopher W.*,†,‡,¶; Farzin, Mahtab†,§; Sioson, Loretta†,§; Watson, Nicole; Brady, Peter W.||; Marshman, David||; Mathur, Manu M.||; Gill, Anthony J.*,†,§

doi: 10.1097/PAT.0b013e32836532ae
Anatomical Pathology

Introduction: The International Association for the Study of Lung Cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ATS/ERS) system which subclassifies lung adenocarcinoma into five distinct types has been widely adopted. We assessed the prognostic value of subclassifying adenocarcinoma in this way in consecutive patients undergoing surgery.

Methods: All patients at our institution undergoing surgery for lung carcinoma between 2000 and 2010 were identified. The original pathology slides were independently reviewed and reclassified according to the 2011 IASLC/ATS/ERS grading and the American Joint Committee on Cancer (AJCC) 7th edition 2009 staging systems.

Results: We identified 270 patients including 152 with adenocarcinoma histology with long-term follow-up. Using the Kaplan–Meier method, the calculated 5 year survival for each of the adenocarcinoma categories were papillary-predominant 80%, lepidic-predominant 71%, micropapillary-predominant 55%, acinar-predominant 43%, solid-predominant 39% and invasive mucinous adenocarcinoma 38%. The AJCC stage was a very strong predictor of survival (p < 0.001). The IASLC/ATS/ERS subclassification of adenocarcinoma demonstrated a trend as a prognostic marker but failed to reach statistical significance in univariate or multivariate analysis.

Conclusion: Although the IASLC/ATS/ERS classification has been validated by several studies in stage I tumours, further studies of larger cohorts will be required to show prognostic value in unselected lung carcinoma undergoing surgery with curative intent.

Author Information

*Sydney Medical School, Sydney

Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards

HistoPath Pathology, North Ryde

§Departments of Anatomical Pathology, and

||Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia

these two authors contributed equally

Address for correspondence: Dr A. J. Gill, Department of Anatomical Pathology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia. E-mail:

Received 27 May, 2013

Revised 13 July, 2013

Accepted 16 July, 2013

© 2013 Royal College of Pathologists of Australasia

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