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Original research
IASLC grading system predicts distant metastases for resected lung adenocarcinoma
  1. Yuezhu Wang1,
  2. Margaret R Smith1,
  3. Caroline B Dixon1,
  4. Ralph D'Agostino2,
  5. Yin Liu1,
  6. Jimmy Ruiz3,
  7. Michael D Chan4,
  8. Jing Su5,
  9. Kathryn F Mileham6,
  10. Thomas Lycan3,
  11. Mary E Green7,
  12. Omer A Hassan8,
  13. Yuming Jiang4,
  14. M Khalid Khan Niazi9,
  15. Wencheng Li10,
  16. Fei Xing1
  1. 1Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  4. 4Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  5. 5Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
  6. 6Department of Solid Tumor Oncology, Levine Cancer Institute, Concord, Massachusetts, USA
  7. 7Eastern Connecticut Pathology Consultants, Manchester, New Hampshire, USA
  8. 8Concord, Nashville, Tennessee, USA
  9. 9Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  10. 10Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Fei Xing, Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA; fxing{at}wakehealth.edu; Dr Wencheng Li, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, USA; wenli{at}wakehealth.edu

Abstract

Aims The International Association for the Study of Lung Cancer (IASLC) has proposed a new histological grading system for invasive lung adenocarcinoma (LUAD). However, the efficacy of this grading system in predicting distant metastases in patients with LUAD remains unexplored. This study aims to assess the potential of the IASLC grading system in predicting the occurrence of brain and bone metastases in patients with resectable LUAD, thereby identifying individuals at high risk of post-surgery distant metastasis.

Methods We retrospectively analysed clinical data and pathological reports of 174 patients with early-stage LUAD who underwent surgical resection between 2008 and 2015 at our cancer center. Patients were monitored for 5 years, and their bone and brain metastasis-free survival rates were determined.

Results 28 out of 174 patients developed distant metastases in 5 years with a median overall survival of 60 months for metastasis-free patients and 38.3 months for patients with distant metastasis. Tumour grading of all samples was evaluated by both IASLC grading and predominant pattern-based grading systems. Receiver operating characteristic (ROC) curves were used to evaluate the predictive capabilities of the IASLC grading system and tumour stage for distant metastasis. Compared with the predominant pattern-based grading system, the IASLC grading system showed a better correlation with the incidence of distant metastasis and lymphovascular invasion. ROC analyses revealed that the IASLC grading system outperformed tumour stage in predicting distant metastasis.

Conclusions Our study indicates that the IASLC grading system is capable of predicting the incidence of distant metastasis among patients with early-stage invasive LUAD.

  • Lung Neoplasms
  • Neoplasm Metastasis
  • Pathology, Surgical

Data availability statement

No data are available.

https://doi.org/10.1136/jcp-2024-209649

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    Data availability statement

    No data are available.

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    Footnotes

    • Handling editor Runjan Chetty.

    • Presented at This work was previously presented as an abstract at the AACR Annual Meeting 2024; April 5–10, 2024; San Diego, California (Cancer Res (2024) 84 (6_Supplement): 3782, https://doi.org/10.1158/1538-7445.AM2024-3782)

    • Contributors YW, FX and WL designed the project, performed analyses and wrote the manuscript. MRS, CBD, YL, JS, YJ, MKKN and RD performed bioinformatics and biostatistics analyses. JR, MDC, KFM, TL identified patients and documented patients’ information. MEG, OAH and WL performed pathological analyses. FX and WL are guarantors.

    • Funding This work was supported by NIH grant R37CA230451. This study used various Shared Resources, including Biostatistics, Tumor Tissue and Pathology, Cancer Genomics, and Cell Engineering, supported by the Comprehensive Cancer Center of Wake Forest University NCI, National Institutes of Health Grant (P30CA012197).

    • Competing interests None declared.

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