Presence of pleomorphic features but not growth patterns improves prognostic stratification of epithelioid malignant pleural mesothelioma by 2-tier nuclear grade.

Autor:	Zhang YZ; National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK.; Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Brambilla C; Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Molyneaux PL; National Heart & Lung Institute, Imperial College London, London, UK.; NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK., Rice A; Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.; National Heart & Lung Institute, Imperial College London, London, UK., Robertus JL; Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.; National Heart & Lung Institute, Imperial College London, London, UK., Jordan S; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Lim E; National Heart & Lung Institute, Imperial College London, London, UK.; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Lang-Lazdunski L; Lung Centre, BUPA Cromwell Hospital, London, UK., Begum S; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Dusmet M; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Anikin V; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK.; Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Beddow E; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Finch J; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Asadi N; Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Popat S; National Heart & Lung Institute, Imperial College London, London, UK.; Department of Medicine, Royal Marsden Hospital NHS Foundation Trust, London, UK.; Institute of Cancer Research, London, UK., Quesne JL; MRC Toxicology Unit, University of Cambridge, Leicester, UK.; Leicester Cancer Research Centre, University of Leicester, Leicester, UK.; Department of Cellular Pathology, University Hospitals Leicester NHS Trust, Leicester, UK., Husain AN; Department of Pathology, University of Chicago Medical Centre, Chicago, USA., Cookson WOCM; National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK.; National Heart & Lung Institute, Imperial College London, London, UK., Moffatt MF; National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK.; National Heart & Lung Institute, Imperial College London, London, UK., Nicholson AG; Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.; National Heart & Lung Institute, Imperial College London, London, UK.
Jazyk:	angličtina
Zdroj:	Histopathology [Histopathology] 2020 Sep; Vol. 77 (3), pp. 423-436. Date of Electronic Publication: 2020 Jun 29.
DOI:	10.1111/his.14127
Abstrakt:	Aims: Nuclear grade has been recently validated as a powerful prognostic tool in epithelioid malignant pleural mesothelioma (E-MPM). In other studies histological parameters including pleomorphic features and growth patterns were also shown to exert prognostic impact. The primary aims of our study are (i) externally validate the prognostic role of pleomorphic features in E-MPM and (ii) investigate if evaluating growth pattern in addition to 2-tier nuclear grade improves prognostication. Methods and Results: 614 consecutive cases of E-MPM from our institution over a period of 15 years were retrospectively reviewed, of which 51 showed pleomorphic features. E-MPM with pleomorphic features showed significantly worse overall survival compared to those without (5.4 versus 14.7 months). Tumours with predominantly micropapillary pattern showed the worst survival (6.2 months) followed by solid (10.5 months), microcystic (15.3 months), discohesive (16.1 months), trabecular (17.6 months) and tubulo-papillary (18.6 months). Sub-classification of growth patterns into high grade (solid, micropapillary) and low grade (all others) led to good separation of overall survival (10.5 versus 18.0 months) but did not predict survival independent of 2-tier nuclear grade. A composite score comprised of growth pattern and 2-tier nuclear grade did not improve prognostication compared with nuclear grade alone. Intra-tumoural heterogeneity in growth patterns is ubiquitous. Conclusions: Our findings support the incorporation of E-MPM with pleomorphic features in the epithelioid subtype as a highly aggressive variant distinct from 2-tier nuclear grade. E-MPM demonstrates extensive heterogeneity in growth pattern but its evaluation does not offer additional prognostic utility to 2-tier nuclear grade. (© 2020 The Authors. Histopathology published by John Wiley & Sons Ltd.)
Databáze:	MEDLINE
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