TY - JOUR T1 - Optimised architecture-based grading system as an independent prognostic factor in resected lung adenocarcinoma JF - Journal of Clinical Pathology JO - J Clin Pathol SP - 176 LP - 184 DO - 10.1136/jclinpath-2020-207104 VL - 75 IS - 3 AU - Jin huan Qiu AU - Gui ming Hu AU - Rui zhen Zhang AU - Menglong Hu AU - Zongkuo Li AU - Yan Zhang AU - Hui fang Wu AU - Wen jing Fu AU - Min Zhang AU - Yi kun Feng AU - Lihua Niu AU - Jing li Ren Y1 - 2022/03/01 UR - http://jcp.bmj.com/content/75/3/176.abstract N2 - 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.Data are available through contacting the corresponding author. ER -