OBJECTIVES Staging of non-small cell lung carcinoma associated with scar is not discussed in detail in the current American Joint Committee on Cancer staging manual. The recommendation is to include the scar area in the tumor size measurement unless the tumor represents a small focus at the edge of the scar. The aim of this study is to investigate if subtraction of the size of the central scar from the total gross size of surgically resected peripheral clinical stage I non-small cell lung carcinoma improves patient stratification into more accurate prognostic groups. MATERIALS AND METHODS Hematoxylin and eosin sections of 148 non-small cell lung carcinomas (98 adenocarcinomas and 50 squamous cell carcinomas) were reviewed, including 44 adenocarcinomas and 9 squamous cell carcinomas with scar and 54 adenocarcinomas and 41 squamous cell carcinomas without scar. The microscopic size of the invasive tumor component was determined after the average percentage of scar tissue was subtracted from the grossly measured tumor diameter. Manual results were compared to digital image analysis. RESULTS Adenocarcinoma with scar were associated with better overall (80.5 % vs. 63.2 %, p = 0.026) and cancer specific survival (95.2 % vs. 73.3 %, p = 0.0053) when compared to adenocarcinoma without scar. Better cancer specific survival was observed in acinar and papillary predominant adenocarcinoma (95.8 % with scar vs. 67.8 % without scar, p = 0.01); while similar trend although not statistically significant was observed in adenocarcinomas with solid or micropapillary component. Using microscopic size, pathologic T stage was down-staged in 21 adenocarcinomas. Squamous cell carcinoma with or without scar did not show a difference in survival. Manual and quantitative image analysis showed strong correlation (r = 0.9769, p < 0.0001). CONCLUSION Our study suggests that microscopic size of the invasive component in acinar and papillary predominant adenocarcinoma with scar might be a better predictor of survival than the total gross size.

中文翻译：

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显微镜下大小在周围疤痕相关的临床I期肺癌中的预后意义。

目的在目前的美国癌症联合委员会分期手册中未详细讨论与疤痕相关的非小细胞肺癌的分期。除非肿瘤在疤痕边缘处有很小的聚焦点，否则建议将疤痕区域包括在肿瘤尺寸测量中。这项研究的目的是研究从手术切除的外周I期非小细胞肺癌的总总大小中减去中央瘢痕的大小是否可以将患者分层改善为更准确的预后组。材料与方法回顾了148例非小细胞肺癌（98例腺癌和50例鳞状细胞癌）的苏木精和曙红切片，其中包括44例腺癌和9例有疤痕的鳞状细胞癌，以及54例腺癌和41例无疤痕的鳞状细胞癌。从总测量的肿瘤直径中减去疤痕组织的平均百分比后，即可确定浸润性肿瘤成分的微观大小。人工结果与数字图像分析进行了比较。结果与无疤痕的腺癌相比，有疤痕的腺癌的总体总体生存率更高（80.5％vs. 63.2％，p = 0.026）和癌症特异性存活率（95.2％，对73.3％，p = 0.0053）。在腺泡和乳头状腺癌中观察到更好的癌症特异性生存率（有疤痕的为95.8％，无疤痕的为67.8％，p = 0.01）；虽然在具有固体或微乳头成分的腺癌中观察到了相似的趋势，尽管没有统计学意义。使用显微镜观察，在21例腺癌中病理T分期被下调。有或没有疤痕的鳞状细胞癌的生存率没有差异。手动和定量图像分析显示出很强的相关性（r = 0.9769，p <0.0001）。结论我们的研究表明，与瘢痕总大小相比，腺泡和乳头状腺癌伴瘢痕的浸润成分的微观大小可能是更好的生存预测指标。