In patients with resected non-small cell lung cancer (NSCLC), the prognostic value of nuclear grade has been demonstrated. However, among patients with advanced, unresectable NSCLC, the prognostic usefulness of cytological nuclear grade to the authors' knowledge remains unknown. In the current study, the authors used transbronchial cytology to investigate whether nuclear morphometry correlated with clinical outcomes in patients with advanced NSCLC.
The authors reviewed patients with advanced, unresectable NSCLC who were diagnosed on transbronchial cytology and were treated at the study institution from 2007 through 2015 (97 patients). Nuclear morphometry (including major diameter) was assessed by an image analysis system and small lymphocytes were used as a reference. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and multivariate analyses were performed using the Cox proportional hazards regression model.
In the multivariate analysis, according to the nuclear major diameter as assessed by an image analysis system, a nuclear major diameter >15 μm was an independent prognostic factor of worse OS (hazard ratio [HR], 1.05; P = .003) and PFS (HR, 1.04; P = 0.011). According to the nuclear major diameter as assessed by small lymphocytes, a major diameter of >5 small lymphocytes was an independent prognostic factor of worse OS (HR, 1.32; P<.001) and PFS (HR, 1.20; P = 0.001). A moderately significant correlation between nuclear diameter measurements by an image analysis system and small lymphocytes was observed (P<.001; correlation coefficient, 0.662).
Nuclear grade based on nuclear diameter was found to be independently associated with prognosis in patients with advanced, unresectable NSCLC. Cancer Cytopathol 2016;124:630-40. © 2016 American Cancer Society.