Article Text

Download PDFPDF
Evaluation of grading systems in stage I lung adenocarcinomas: a retrospective cohort study
  1. Tamás Zombori1,
  2. József Furák2,
  3. Tibor Nyári3,
  4. Gábor Cserni1,4,
  5. László Tiszlavicz1
  1. 1 Department of Pathology, University of Szeged, Szeged, Hungary
  2. 2 Department of Surgery, University of Szeged, Szeged, Hungary
  3. 3 Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
  4. 4 Department of Pathology, Bács-Kiskun County Teaching Hospital, Szeged, Hungary
  1. Correspondence to Dr Tamás Zombori, Department of Pathology, University of Szeged, Faculty of Medicine Állomás, u. 1. H6725 Szeged, Hungary; zomtam{at}


Aims There is no internationally accepted grading system for lung adenocarcinoma despite the new WHO classification. The architectural grade, the Kadota grade and the Sica score were evaluated and compared with overall (OS) and disease-free survival (DFS).

Methods Comprehensive histological subtyping was used in a series of resected stage I lung adenocarcinoma to identify subtypes of adenocarcinomas, the architectural grade, the Kadota grade, the Sica grade, the mitotic count, nuclear atypia, the presence of lymphovascular, vascular and airway propagation, necrosis, and micropapillary or solid growth pattern in any percentage. Statistical models fitted included Kaplan-Meier estimates and Cox proportional hazard regression models.

Results 261 stage I adenocarcinomas were included. The 5-year survivals of different subtypes were as follows: lepidic (n=40, OS: 92.5%; DFS 91.6%), acinar (n=54, OS: 81.8%; DFS: 68.6%), papillary (n=49, OS: 73.6%; DFS: 61.0%), solid (n=95, OS: 64.7%; DFS: 57.8%) and micropapillary (n=23, OS: 34.8%; DFS: 33.5%). Concerning the architectural grade, there were significant differences between OS and DFS of low and intermediate (pOS=0.005, pDFS<0.001), low and high (pOS<0.001, pDFS<0.001) and intermediate and high grades (pOS=0.002, pDFS<0.001). Low-grade and intermediate grade tumours did not differ in survival according to Kadota grade and Sica grade. In the multivariable model, architectural grade was found to be an independent prognostic marker. In another model, architectural pattern proved to be superior to architectural grade.

Conclusions Of the three grading systems compared, the architectural grade makes the best distinction between the outcome of low-grade, intermediate-grade and high-grade stage I adenocarcinomas.

  • Stage I
  • lung adenocarcinoma
  • architectural grade
  • Kadota-grade
  • Sica-score
  • overall survival
  • disease-free survival

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Cheok Soon Lee.

  • Contributors Conceptualisation: TZ, GC, LT and JF. Methodology: TZ. Investigation: TZ and LT. Formal analysis: TZ and TN. Writing — original draft: TZ and GC. Writing — review and editing: TZ, GC, LT and JF. Resources (data): JF. Supervision: GC and LT. Revision: TZ, TN and GC. Approval of final version: All authors.

  • Funding The study was funded by the National Research, Development and Innovation Office grant GINOP-2.3.2-15-2016-00020.

  • Competing interests None declared.

  • Ethics approval Regional Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.