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Clinical significance of the cribriform pattern in invasive adenocarcinoma of the lung
  1. Ruizhen Zhang1,2,
  2. Guiming Hu1,2,
  3. Jinhuan Qiu1,3,
  4. Huifang Wu1,
  5. Wenjing Fu1,
  6. Yikun Feng1,
  7. Min Zhang1,
  8. Chen Chen1,
  9. Jianping Sun1,
  10. Yan Zhang1,
  11. Jingli Ren1
  1. 1 Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
  2. 2 Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
  3. 3 Department of Thoracic Surgery, The SecondAffiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
  1. Correspondence to Professor Jingli Ren, zhengzhou, China; jingliren123002{at}


Purpose According to the WHO, the cribriform pattern is a subtype of acinar (Aci) predominance in invasive adenocarcinoma (ADC) of the lung. Recently, several studies have demonstrated poor prognosis in patients with cribriform predominance. This study was performed to examine the correlations of cribriform pattern with the clinicopathology, molecular features and prognosis in patients with invasive ADC.

Methods Histological subtypes were evaluated in 279 patients who underwent complete resection for invasive ADC. Patients of the Aci-predominant subtype were divided into two subgroups according to the percentage of cribriform cancer (≥5% vs <5%). Clinicopathological characteristics, overall survival (OS), disease-free survival (DFS) and molecular changes were compared. In addition, both OS and DFS were compared between patients with cribriform-predominant (n=33) and pure Aci-predominant (n=88) ADCs.

Results A cribriform pattern was found in 111 (39.8%) cases and ranged from 5 % to 100 % of the total tumour volume (mean±SEM, 30%±2%). Of 117 patients with Aci predominance, 79 showed the cribriform pattern, while the remaining 38 did not. The cribriform pattern was associated with aggressive pathological behaviour, including advanced stages of cancer, nuclear atypia, mitoses, lymph node invasion, metastasis and larger tumour size. The subgroup with cribriform cancer (≥5%) had significantly poorer OS and DFS compared with the cribriform-negative (<5%) group. In addition, Cox multivariate analyses revealed that the cribriform pattern was an independent predictor of OS but not DFS. Moreover, OS was significantly lower in the cribriform-predominant group than in the Aci-predominant group.

Conclusion The cribriform pattern is associated with aggressive pathological behaviour and is an independent poor prognostic indicator in patients with Aci-predominant ADC of the lung.

  • cribriform
  • prognosis
  • acinar
  • lung adenocarcinoma

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  • Handling editor Runjan Chetty.

  • Contributors The corresponding authors directed the research. RZ completed the main article framework and written documents. GH retrospectively analysed the pathological sections. JQ provided clinical information. HW analysed the date. The other authors revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

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

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information.