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Optimised architecture-based grading system as an independent prognostic factor in resected lung adenocarcinoma
  1. Jin huan Qiu1,2,
  2. Gui ming Hu1,2,
  3. Rui zhen Zhang1,3,
  4. Menglong Hu1,2,
  5. Zongkuo Li1,2,
  6. Yan Zhang1,
  7. Hui fang Wu1,
  8. Wen jing Fu1,
  9. Min Zhang1,
  10. Yi kun Feng1,
  11. Lihua Niu1,
  12. Jing li Ren1
  1. 1Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
  2. 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
  3. 3Department of Thoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
  1. Correspondence to Professor Jing li Ren, Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China; jingliren123002{at}


Aims Considering morphological heterogeneity of lung adenocarcinoma (LUAD) and no objective prognostic grading system existing currently, we aim to establish an ‘optimised architecture-based grading system’ (OAGS) to predict prognosis for resected LUAD.

Methods A multicentral study involving three independent cohorts of LUAD was conducted. Predictive ability of the OAGS for recurrence-free probability (RFP) and overall survival (OS) was assessed in training cohort (n=228) by the area under the receiver operating characteristic curve (AUC), Harrell’s concordance index (C-index) and Kaplan-Meier survival analyses, which was validated in testing (n=135) and validation (n=226) cohorts.

Results The OAGS consists of: grade 1 for lepidic, papillary or acinar predominant tumour with no or less than 5% of high-grade patterns (cribriform, solid and or micropapillary), grade 2 for lepidic, papillary or acinar predominant tumour with 5% or more of high-grade patterns, and grade 3 for cribriform, solid or micropapillary predominant tumour. In all stages, the OAGS outperformed the pattern-dominant grading system and IASLC grading system for predicting RFP (C-index, 0.649; AUC, 0.742) and OS (C-index, 0.685; AUC, 0.754). Multivariate analysis identified it as an independent predictor of both (RFP, p<0.001; OS, p<0.001). Furthermore, in pT1-2aN0M0 subgroup, the OAGS maintained its ability to predict recurrence (C-index, 0.699; AUC, 0.769) and stratified patients into different risk groups of RFP (p<0.001). These results were confirmed in testing and validation cohorts.

Conclusions The OAGS is an independent prognostic factor and shows a robust ability to predict prognosis for resected LUAD.

  • lung neoplasms
  • pathology department
  • hospital
  • biomarkers
  • tumour
  • diagnosis

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  • Handling editor Dhirendra Govender.

  • Contributors Conception and design: JhQ, GmH and JlR. Review of the pathological sections: JlR, GmH and HfW. Provision of study materials or patients: WjF, MZ, YkF and LN. Collection and assembly of data: all authors. Data analysis and interpretation: JhQ, RzZ, MH and ZL. Manuscript writing: all authors. Final approval of manuscript: all authors.

  • Funding This study was supported by the Key Scientific Research Project Plans of Higher Education Institutions in Henan Province (Grant NO. 19B320020) and Joint Construction Project of Henan Medical Science and Technology Project (Grant No. 2018020148).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This retrospective, population-based study was approved by the Zhengzhou University Ethics Committee.

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

  • Data availability statement Data are available through contacting the corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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