Proposal of a revised International Association for the Study of Lung Cancer grading system in pulmonary non-mucinous adenocarcinoma: The importance of the lepidic proportion

•IASLC grading system has acceptable performance in diverse populations.•We proposed IASLC modification for increasing predictability in Korean patients.•Lepidic proportion further differentiated IASLC grade 2 patients. We aimed to measure the validity of the International Association for the Study...

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Published in:Lung cancer (Amsterdam, Netherlands) Netherlands), 2023-01, Vol.175, p.1-8
Main Authors: Park, Byung Jo, Woo, Wongi, Cha, Yoon Jin, Shim, Hyo Sup, Yang, Young Ho, Moon, Duk Hwan, Kim, Bong Jun, Kim, Ha Eun, Kim, Dae Joon, Paik, Hyo Chae, Lee, Jin Gu, Lee, Sungsoo, Lee, Chang Young
Format: Article
Language:English
Subjects:
Adenocarcinoma
Adenocarcinoma - pathology
Adenocarcinoma of Lung - pathology
Area under curve
Concordance index
Histological labeling
Humans
Lung
Lung Neoplasms - pathology
Neoplasm Staging
Predictive model
Retrospective Studies
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Summary:•IASLC grading system has acceptable performance in diverse populations.•We proposed IASLC modification for increasing predictability in Korean patients.•Lepidic proportion further differentiated IASLC grade 2 patients. We aimed to measure the validity of the International Association for the Study of Lung Cancer (IASLC) grading system in Korean patients and propose a modification for an increase of its predictability, especially in grade 2 patients. From 2012 to 2017, histopathologic characteristics of 1358 patients with invasive pulmonary adenocarcinoma (stage I–III) from two institutions were retrospectively reviewed and re-classified according to the IASLC grading system. Considering the amount of the lepidic proportion, the validity of the revised model (Lepidic-10), derived from the training cohort (hospital A), was measured using the validation cohort (hospital B). Its predictability was compared to that of the IASLC system. Of the 1358 patients, 259 had a recurrence, and 189 died during follow-up. The Harrell’s concordance index and area under the curve of the IASLC system were 0.685 and 0.699 for recurrence-free survival (RFS) and 0.669 and 0.679 for death, respectively. From the training cohort, the IASLC grade 2 patients were divided into grades 2a and 2b (Lepidic-10 model) with a 10 % lepidic pattern. This new model further distinguished patients in both institutions that had better performance than the IASLC grading (Hospital A, p 
ISSN:0169-5002
1872-8332
DOI:10.1016/j.lungcan.2022.11.003