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Reproducibility of 3 histologic classifications and 3 staging systems for thymic epithelial neoplasms and its effect on prognosis.

胸腺上皮性肿瘤中3种组织学分类和3种分期系统的重复性及其对预后的影响

Roden AC,Yi ES,Jenkins SM,Edwards KK,Donovan JL,Lewis JE,Cassivi SD,Marks RS,Garces YI,Aubry MC

Abstract

Data regarding the prognostic significance of the histopathologic classifications of thymic epithelial neoplasms are contradictory, perhaps reflecting issues in reproducibility. We studied the effect of reproducibility of 3 histopathologic classifications on prognosis and investigated the interobserver agreement on invasion and its effect on staging and prognosis. A total of 456 patients who underwent surgery for thymic epithelial neoplasm at Mayo Clinic Rochester (1942 to 2008) were staged (modified Masaoka, proposed Moran, proposed IASLC/ITMIG) and independently classified by 3 thoracic pathologists (World Health Organization, proposed Suster & Moran [S&M], and Bernatz). Interobserver agreement was moderate to substantial for all histopathologic classifications (κ values: 0.65, 0.52, 0.74 for World Health Organization, Bernatz, and S&M, respectively). All histopathologic classifications were significant for overall survival (OS) and disease-free survival (DFS) (all reviewers). If adjusted for Masaoka, only Bernatz classification for one reviewer and all histopathologic classifications for another reviewer were significant for OS. Interobserver agreement for invasion was substantial (κ=0.61) and almost perfect for Masaoka, Moran, and IASLC/ITMIG stage (κ values: 0.85, 0.81, and 0.92, respectively). The correlation coefficient for Masaoka and Moran staging was 0.93. Masaoka and IASLC/ITMIG staging were significant for OS and DFS (all reviewers). If adjusted for any histopathologic classification, Masaoka was significant for OS and DFS (all reviewers). In conclusion, reproducibility of histopathologic classifications has some effect on outcome. S&M is the most reproducible classification. Reproducibility of invasion has no effect on the prognostic value of staging. Masaoka, Moran, and IASLC/ITMIG staging are almost perfectly reproducible. The strong correlation between Masaoka and Moran staging suggests similar prognostic strength.

摘要

关于胸腺上皮性肿瘤组织学分类预后意义方面的资料是有矛盾的,这种矛盾性或许反映了重复性问题。我们研究了3种组织病理学分类的一致性对预后的影响,同时调查了这些组织学分类在浸润和其对分期及预后影响上的观察者间一致性。研究者收集了罗彻斯特的梅奥诊所1942-2008年手术切除的456例胸腺上皮性肿瘤进行分期(采用修改的Masaoka,建议的Moran和建议的IASLC/ITMG分期),并由3个胸外科病理医生独立进行分类(组织学分类分别采用WHO、建议的Suster&Moran[S&M]和Bernatz)。所有的组织学类型之间,观察者间的一致性为中到高度(WHO、建议的Suster&Moran[S&M]和Bernatz的κ值分别为0.65/0.52和0.74)。(全部阅片者的)所有组织学分类对总生存期(OS)和无病生存期(DFS)均有意义。如果对Msasoka进行调整,一个阅片者仅有Bernatz对OS有意义,而另一个阅片者则所有组织学分类对OS均有意义。观察者之间对浸润的确定具有较高的一致性(κ=0.61),Masaoka,Moran和IASLC/ITMIG分期几乎是一样的(κ分别为0.85,0.81和0.92)。Masaoka和Moran分期的相关系数为0.93,所有阅片者均显示Masaoka和IASLC/IMTG分期对OS和DFS有价值。总之,组织学分类具有一定的重复性,对预后有一些影响。S&M是最有重复性的分类。浸润的重复性对分期的预后价值没有影响。Masaoka、Moran和IACLS/ITMG的重复性是几乎完美的。Masaoka和Moran分期强相关性提示它们对预后具有相同的价值。

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