原発性肺腺癌の組織学的多彩性とグレード分類
肺癌は癌死の原因の上位を占める高悪性腫瘍の一つである．その中で最も多くを占めているのが肺腺癌であり，その割合は徐々に増加してきている．肺腺癌は多彩な組織像を示す．その大多数を占める浸潤性非粘液性腺癌は5 つの亜型にわけられる．2015 年のWHO分類では5 つの組織パターン（置換型，腺房型，乳頭型，微小乳頭型，充実型）が定められ，最も優位なパターン増殖を持って置換型腺癌，腺房型腺癌，乳頭型腺癌，微小乳頭型腺癌，充実型腺癌と分類され予後との強い相関を認めた．しかしながら，優位組織パターン以外でも微小乳頭型または充実型の存在や複雑腺系型の出現により，2021 年のWHO 分類では最も優位なパターン...
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| Published in | 岩手医学雑誌 Vol. 77; no. 1; pp. 1 - 14 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
岩手医学会
01.05.2025
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| Online Access | Get full text |
| ISSN | 0021-3284 2434-0855 |
| DOI | 10.24750/iwateishi.77.1_1 |
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| Abstract | 肺癌は癌死の原因の上位を占める高悪性腫瘍の一つである．その中で最も多くを占めているのが肺腺癌であり，その割合は徐々に増加してきている．肺腺癌は多彩な組織像を示す．その大多数を占める浸潤性非粘液性腺癌は5 つの亜型にわけられる．2015 年のWHO分類では5 つの組織パターン（置換型，腺房型，乳頭型，微小乳頭型，充実型）が定められ，最も優位なパターン増殖を持って置換型腺癌，腺房型腺癌，乳頭型腺癌，微小乳頭型腺癌，充実型腺癌と分類され予後との強い相関を認めた．しかしながら，優位組織パターン以外でも微小乳頭型または充実型の存在や複雑腺系型の出現により，2021 年のWHO 分類では最も優位なパターンと高悪性度パターン（微小乳頭型，充実型，複雑腺系型）を組み合わせた分類が発表され，予後予測により優れていた．肺腺癌の組織形態は予後とダイナミックに関連しており，形態学の有用性を改めて認識するものであった． |
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| AbstractList | 肺癌は癌死の原因の上位を占める高悪性腫瘍の一つである．その中で最も多くを占めているのが肺腺癌であり，その割合は徐々に増加してきている．肺腺癌は多彩な組織像を示す．その大多数を占める浸潤性非粘液性腺癌は5 つの亜型にわけられる．2015 年のWHO分類では5 つの組織パターン（置換型，腺房型，乳頭型，微小乳頭型，充実型）が定められ，最も優位なパターン増殖を持って置換型腺癌，腺房型腺癌，乳頭型腺癌，微小乳頭型腺癌，充実型腺癌と分類され予後との強い相関を認めた．しかしながら，優位組織パターン以外でも微小乳頭型または充実型の存在や複雑腺系型の出現により，2021 年のWHO 分類では最も優位なパターンと高悪性度パターン（微小乳頭型，充実型，複雑腺系型）を組み合わせた分類が発表され，予後予測により優れていた．肺腺癌の組織形態は予後とダイナミックに関連しており，形態学の有用性を改めて認識するものであった． |
| Author | 栁川, 直樹 |
| Author_xml | – sequence: 1 fullname: 栁川, 直樹 organization: 岩手医科大学医学部，病理診断学講座 |
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| References | Siegel RL, Miller KD, Wagle NS, et al.: Cancer statistics, 2023. CA Cancer J Clin 73, 17-48, 2023. Tsuta K, Kawago M, Inoue E, et al.: The utility of the proposed IASLC/ATS/ERS lung adenocarcinoma subtypes for disease prognosis and correlation of driver gene alterations. Lung Cancer 81, 371-376, 2013. Sica G, Yoshizawa A, Sima CS, et al.: A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stage I tumors. Am J Surg Pathol 34, 1155-1162, 2010. Warth A, Muley T, Meister M, et al.: The novel histologic international association for the study of lung cancer/american thoracic society/european respiratory society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol 30, 1438-1446, 2012. Cha MJ, Lee HY, Lee KS, et al.: Micropapillary and solid subtypes of invasive lung adenocarcinoma: clinical predictors of histopathology and outcome. J Thorac Cardiovasc Surg 147, 921-928, 2014. Moreira AL, Ocampo PSS, Xia Y, et al.: A grading system for invasive pulmonary adenocarcinoma: a proposal from the International association for the study of lung cancer pathology committee. J Thorac Oncol 15, 1599-1610, 2020. Yanagawa N, Sugai M, Shikanai S, et al.: The new IASLC grading system for invasive nonmucinous lung adenocarcinoma is a more useful indicator of patient survival compared with previous grading systems. J Surg Oncol 127, 174-182, 2023. Yanagawa N, Shiono S, Abiko M, et al.: New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage I lung adenocarcinoma. J Thorac Oncol 8, 612-618, 2013. Yanagawa N, Shiono S, Abiko M, et al.: The clinical impact of solid and micropapillary patterns in resected lung adenocarcinoma. J Thorac Oncol 11, 1976-1983, 2016. 日本肺癌学会: 臨床・病理 肺癌取扱い規約 第8版補訂版．金原出版，東京，2021 日本肺癌学会: WHO 分類第5 版に準拠した胸部腫瘍組織分類2021［updated 2022 年1 月13 日］．第1. 3 版, https://www.haigan.gr.jp/modules/important/index.php?content_id=248 Travis W， Brambilla E， Burke AP，et al.: WHO Classification of Tumours of the Lung， Pleura，Thymus and Heart, 4th ed, IARC, Lyon, 2015 Suzuki M, Yokose T and Nakayama H: Prognostic contribution of non-predominant solid and micropapillary components in lung adenocarcinomas. JThorac Dis 9, 504-506, 2017. Yanagawa N, Shiono S, Abiko M, et al.: The correlation of the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification with prognosis and EGFR mutation in lung adenocarcinoma. Ann Thorac Surg 98, 453-458, 2014. Kadota K, Kushida Y, Kagawa S, et al.: Cribriform subtype is an independent predictor of recurrence and survival after adjustment for the eighth edition of TNM staging system in patients with resected lung adenocarcinoma．J Thorac Oncol 14, 245-254, 2019 WHO Classification of Tumours Editorial Board：WHO Classification of Tumours -Thoracic Tumours, 5th ed, IARC, Lyon, 2021. Kuang M， Shen X， Yuan C, et al.: Clinical significance of complex glandular patterns in lung adenocarcinoma: clinicopathologic and molecular study in a large series of cases. Am J CIin Pathol 150, 65-73, 2018 Yoshizawa A, Sumiyoshi S, Sonobe M, et al.: Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol 8, 52-61, 2013. |
| References_xml | – reference: Tsuta K, Kawago M, Inoue E, et al.: The utility of the proposed IASLC/ATS/ERS lung adenocarcinoma subtypes for disease prognosis and correlation of driver gene alterations. Lung Cancer 81, 371-376, 2013. – reference: 日本肺癌学会: 臨床・病理 肺癌取扱い規約 第8版補訂版．金原出版，東京，2021． – reference: Yanagawa N, Shiono S, Abiko M, et al.: New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage I lung adenocarcinoma. J Thorac Oncol 8, 612-618, 2013. – reference: Kuang M， Shen X， Yuan C, et al.: Clinical significance of complex glandular patterns in lung adenocarcinoma: clinicopathologic and molecular study in a large series of cases. Am J CIin Pathol 150, 65-73, 2018． – reference: Yanagawa N, Sugai M, Shikanai S, et al.: The new IASLC grading system for invasive nonmucinous lung adenocarcinoma is a more useful indicator of patient survival compared with previous grading systems. J Surg Oncol 127, 174-182, 2023. – reference: Siegel RL, Miller KD, Wagle NS, et al.: Cancer statistics, 2023. CA Cancer J Clin 73, 17-48, 2023. – reference: Cha MJ, Lee HY, Lee KS, et al.: Micropapillary and solid subtypes of invasive lung adenocarcinoma: clinical predictors of histopathology and outcome. J Thorac Cardiovasc Surg 147, 921-928, 2014. – reference: Yanagawa N, Shiono S, Abiko M, et al.: The clinical impact of solid and micropapillary patterns in resected lung adenocarcinoma. J Thorac Oncol 11, 1976-1983, 2016. – reference: Yanagawa N, Shiono S, Abiko M, et al.: The correlation of the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification with prognosis and EGFR mutation in lung adenocarcinoma. Ann Thorac Surg 98, 453-458, 2014. – reference: Suzuki M, Yokose T and Nakayama H: Prognostic contribution of non-predominant solid and micropapillary components in lung adenocarcinomas. JThorac Dis 9, 504-506, 2017. – reference: Moreira AL, Ocampo PSS, Xia Y, et al.: A grading system for invasive pulmonary adenocarcinoma: a proposal from the International association for the study of lung cancer pathology committee. J Thorac Oncol 15, 1599-1610, 2020. – reference: Travis W， Brambilla E， Burke AP，et al.: WHO Classification of Tumours of the Lung， Pleura，Thymus and Heart, 4th ed, IARC, Lyon, 2015． – reference: 日本肺癌学会: WHO 分類第5 版に準拠した胸部腫瘍組織分類2021［updated 2022 年1 月13 日］．第1. 3 版, https://www.haigan.gr.jp/modules/important/index.php?content_id=248． – reference: Yoshizawa A, Sumiyoshi S, Sonobe M, et al.: Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol 8, 52-61, 2013. – reference: Warth A, Muley T, Meister M, et al.: The novel histologic international association for the study of lung cancer/american thoracic society/european respiratory society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol 30, 1438-1446, 2012. – reference: WHO Classification of Tumours Editorial Board：WHO Classification of Tumours -Thoracic Tumours, 5th ed, IARC, Lyon, 2021. – reference: Sica G, Yoshizawa A, Sima CS, et al.: A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stage I tumors. Am J Surg Pathol 34, 1155-1162, 2010. – reference: Kadota K, Kushida Y, Kagawa S, et al.: Cribriform subtype is an independent predictor of recurrence and survival after adjustment for the eighth edition of TNM staging system in patients with resected lung adenocarcinoma．J Thorac Oncol 14, 245-254, 2019． |
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| Snippet | 肺癌は癌死の原因の上位を占める高悪性腫瘍の一つである．その中で最も多くを占めているのが肺腺癌であり，その割合は徐々に増加してきている．肺腺癌は多彩な組織像を示す．その大多数を占める浸潤性非粘液性腺癌は5 つの亜型にわけられる．2015 年のWHO分類では5... |
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| Title | 原発性肺腺癌の組織学的多彩性とグレード分類 |
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