Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma
Abstract Background The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer adopts new criteria for tumor size, and for determining pTis, pT1a(mi), and pT1a. The latter is based on the size of stromal invasion. It is quite challenging for lung pathologists....
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Thoracic Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/1759-7714.14785 |
| _version_ | 1828004025575931904 |
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| author | Yu‐Ting Wang Il‐Chi Chang Chih‐Yi Chen Jiun‐Yi Hsia Frank Cheau‐Feng Lin Wan‐Ru Chao Tuan‐Ying Ke Ya‐Ting Chen Chih‐Jung Chen Min‐Shu Hsieh Shiu‐Feng Huang |
| author_facet | Yu‐Ting Wang Il‐Chi Chang Chih‐Yi Chen Jiun‐Yi Hsia Frank Cheau‐Feng Lin Wan‐Ru Chao Tuan‐Ying Ke Ya‐Ting Chen Chih‐Jung Chen Min‐Shu Hsieh Shiu‐Feng Huang |
| author_sort | Yu‐Ting Wang |
| collection | DOAJ |
| description | Abstract Background The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer adopts new criteria for tumor size, and for determining pTis, pT1a(mi), and pT1a. The latter is based on the size of stromal invasion. It is quite challenging for lung pathologists. Methods All patients who had undergone surgical resection for pulmonary adenocarcinoma (ADC) at Chung Shan Medical University Hospital between January 2014 and April 2018 were reviewed, and restaged according to the eighth AJCC staging system. The clinical characteristics and survival of patients with tumor stage 0 (pTis), I or II were analyzed. Results In total, 376 patients were analyzed. None of the pTis, pT1a(mi), or pT1a tumors recurred during the follow‐up period up to 5 years, but pT1b, pT1c, pT2a, and pT2b tumors all had a few tumor recurrences (p < 0.0001). In addition, 95.2%, 100%, and 77.5% of pTis, pT1a(mi), and pT1a tumors, respectively, had tumor sizes ≤1.0 cm by gross examination. All pTis, pT1a(mi), and pT1a tumors exhibited only lepidic, acinar, or papillary patterns histologically. Conclusions This study demonstrated excellent survival for lung ADC patients with pTis, pT1a(mi), and pT1a tumors when completely excised. To reduce the inconsistencies between pathologists, staging lung ADC with tumors of ≤1 cm in size grossly as pTis, pT1a(mi), or pT1a may not be necessary when the tumors exhibit only lepidic, acinar, or papillary histological patterns. A larger cohort study with sufficient follow‐up data is necessary to support this proposal. |
| first_indexed | 2024-04-10T07:07:58Z |
| format | Article |
| id | doaj.art-0ff50e5972c44e84be8e43b876405b44 |
| institution | Directory Open Access Journal |
| issn | 1759-7706 1759-7714 |
| language | English |
| last_indexed | 2024-04-10T07:07:58Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Thoracic Cancer |
| spelling | doaj.art-0ff50e5972c44e84be8e43b876405b442023-02-27T01:36:59ZengWileyThoracic Cancer1759-77061759-77142023-02-0114659260110.1111/1759-7714.14785Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinomaYu‐Ting Wang0Il‐Chi Chang1Chih‐Yi Chen2Jiun‐Yi Hsia3Frank Cheau‐Feng Lin4Wan‐Ru Chao5Tuan‐Ying Ke6Ya‐Ting Chen7Chih‐Jung Chen8Min‐Shu Hsieh9Shiu‐Feng Huang10Department of Anatomical Pathology Chung Shan Medical University Hospital Taichung TaiwanInstitute of Molecular and Genomic Medicine National Health Research Institutes Miaoli TaiwanDepartment of Thoracic Surgery Chung Shan Medical University Hospital Taichung TaiwanDepartment of Thoracic Surgery Chung Shan Medical University Hospital Taichung TaiwanDepartment of Thoracic Surgery Chung Shan Medical University Hospital Taichung TaiwanDepartment of Anatomical Pathology Chung Shan Medical University Hospital Taichung TaiwanDepartment of Anatomical Pathology Chung Shan Medical University Hospital Taichung TaiwanInstitute of Molecular and Genomic Medicine National Health Research Institutes Miaoli TaiwanDepartment of Pathology and Laboratory Medicine Taichung Veterans General Hospital Taichung TaiwanDepartment of Pathology National Taiwan University Hospital Taipei TaiwanDepartment of Anatomical Pathology Chung Shan Medical University Hospital Taichung TaiwanAbstract Background The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer adopts new criteria for tumor size, and for determining pTis, pT1a(mi), and pT1a. The latter is based on the size of stromal invasion. It is quite challenging for lung pathologists. Methods All patients who had undergone surgical resection for pulmonary adenocarcinoma (ADC) at Chung Shan Medical University Hospital between January 2014 and April 2018 were reviewed, and restaged according to the eighth AJCC staging system. The clinical characteristics and survival of patients with tumor stage 0 (pTis), I or II were analyzed. Results In total, 376 patients were analyzed. None of the pTis, pT1a(mi), or pT1a tumors recurred during the follow‐up period up to 5 years, but pT1b, pT1c, pT2a, and pT2b tumors all had a few tumor recurrences (p < 0.0001). In addition, 95.2%, 100%, and 77.5% of pTis, pT1a(mi), and pT1a tumors, respectively, had tumor sizes ≤1.0 cm by gross examination. All pTis, pT1a(mi), and pT1a tumors exhibited only lepidic, acinar, or papillary patterns histologically. Conclusions This study demonstrated excellent survival for lung ADC patients with pTis, pT1a(mi), and pT1a tumors when completely excised. To reduce the inconsistencies between pathologists, staging lung ADC with tumors of ≤1 cm in size grossly as pTis, pT1a(mi), or pT1a may not be necessary when the tumors exhibit only lepidic, acinar, or papillary histological patterns. A larger cohort study with sufficient follow‐up data is necessary to support this proposal.https://doi.org/10.1111/1759-7714.14785adenocarcinoma in situAJCC staging systemlung adenocarcinomaminimally invasive adenocarcinomarecurrence |
| spellingShingle | Yu‐Ting Wang Il‐Chi Chang Chih‐Yi Chen Jiun‐Yi Hsia Frank Cheau‐Feng Lin Wan‐Ru Chao Tuan‐Ying Ke Ya‐Ting Chen Chih‐Jung Chen Min‐Shu Hsieh Shiu‐Feng Huang Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma Thoracic Cancer adenocarcinoma in situ AJCC staging system lung adenocarcinoma minimally invasive adenocarcinoma recurrence |
| title | Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma |
| title_full | Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma |
| title_fullStr | Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma |
| title_full_unstemmed | Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma |
| title_short | Challenges of the eighth edition of the American Joint Committee on Cancer staging system for pathologists focusing on early stage lung adenocarcinoma |
| title_sort | challenges of the eighth edition of the american joint committee on cancer staging system for pathologists focusing on early stage lung adenocarcinoma |
| topic | adenocarcinoma in situ AJCC staging system lung adenocarcinoma minimally invasive adenocarcinoma recurrence |
| url | https://doi.org/10.1111/1759-7714.14785 |
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