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Proposal of a revised International Association for the Study of Lung Cancer grading system in pulmonary non-mucinous adenocarcinoma: The importance of the lepidic proportion

 Byung Jo Park  ;  Wongi Woo  ;  Yoon Jin Cha  ;  Hyo Sup Shim  ;  Young Ho Yang  ;  Duk Hwan Moon  ;  Bong Jun Kim  ;  Ha Eun Kim  ;  Dae Joon Kim  ;  Hyo Chae Paik  ;  Jin Gu Lee  ;  Sungsoo Lee  ;  Chang Young Lee 
 LUNG CANCER, Vol.175 : 1-8, 2023-01 
Journal Title
Issue Date
Adenocarcinoma of Lung* / pathology ; Adenocarcinoma* / pathology ; Humans ; Lung Neoplasms* / pathology ; Neoplasm Staging ; Retrospective Studies
Adenocarcinoma ; Area under curve ; Concordance index ; Histological labeling ; Lung ; Predictive model
Objectives: We aimed to measure the validity of the International Association for the Study of Lung Cancer (IASLC) grading system in Korean patients and propose a modification for an increase of its predictability, especially in grade 2 patients.

Materials and methods: From 2012 to 2017, histopathologic characteristics of 1358 patients with invasive pulmonary adenocarcinoma (stage I-III) from two institutions were retrospectively reviewed and re-classified according to the IASLC grading system. Considering the amount of the lepidic proportion, the validity of the revised model (Lepidic-10), derived from the training cohort (hospital A), was measured using the validation cohort (hospital B). Its predictability was compared to that of the IASLC system.

Results: Of the 1358 patients, 259 had a recurrence, and 189 died during follow-up. The Harrell's concordance index and area under the curve of the IASLC system were 0.685 and 0.699 for recurrence-free survival (RFS) and 0.669 and 0.679 for death, respectively. From the training cohort, the IASLC grade 2 patients were divided into grades 2a and 2b (Lepidic-10 model) with a 10 % lepidic pattern. This new model further distinguished patients in both institutions that had better performance than the IASLC grading (Hospital A, p < 0.001 for RFS and death; Hospital B, p = 0.0215 for RFS, p = 0.0429 for death).

Conclusion: The IASLC grading system was easily applicable; its clinical use in predicting the prognosis of Korean patients with pulmonary adenocarcinoma was validated. Furthermore, the introduction of the lepidic proportion as an additional criterion to differentiate grade 2 patients improved its predictability.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Kim, Bong Joon(김봉준)
Kim, Ha Eun(김하은)
Moon, Duk Hwan(문덕환)
Park, Byung Jo(박병조)
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Shim, Hyo Sup(심효섭) ORCID logo https://orcid.org/0000-0002-5718-3624
Yang, Young Ho(양영호)
Woo, Wongi(우원기) ORCID logo https://orcid.org/0000-0002-0053-4470
Lee, Sung Soo(이성수) ORCID logo https://orcid.org/0000-0001-8998-9510
Lee, Jin Gu(이진구)
Lee, Chang Young(이창영)
Cha, Yoon Jin(차윤진) ORCID logo https://orcid.org/0000-0002-5967-4064
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