The Distribution And Pathological Significance Of Elastic Fibers In Lung Adenocarcinoma

Objective(1)To explore the distribution and the significance of elastic fibers between adenocarcinoma in situ and invasive adenocarcinoma of lung of the interstitial.(2)Through the distribution of elastic fibers in pleural of lung adenocarcinoma,to explore the clinical significance and prognosis of visceral pleural invasion(VPI)of lung adenocarcinoma.Methods 430 cases of lung cancer samples from January 2012 to August 2014 have been collected in Anhui Medical University.123 cases of lung adenocarcinoma with complete clinical data,accurate follow-up record and close to pleural area were selected,including invasive lung adenocarcinoma of 88 cases,adenocarcinoma in situ of 35 cases.Another 20 normal lung tissues were selected as control group.All of the samples have been storage as paraffin blocks and dyed in hematoxylin-eosin(HE)and EF.(1)A11 cases were categorized into three elastic fiber patterns(EFP):Complete absence or fineness,fracture(EFP Ⅰ),diffuse increase and neatly arranged(EFPⅡ),consistently obvious hyperplasia(EFP Ⅲ),then analyed the pathological significance and clinical prognosis of Elastic Fibers between adenocarcinoma in situ and invasive adenocarcinoma of lung.(2)VPI in invasive lung adenocarcinoma was diagnosed according to the modified Hammar grading criteria,and elaborately separated in three groups PLO,PL1 and PL2.Explore the clinical significance of VPI in invasive lung adenocarcinoma.The chi-square test was used in the comparison among groups.Kaplan-Meier was used to analyze the overall survival(OS)and disease-free survival(DFS).Long-rank was used to compare with the rate of OS and DFS.COX multivariate regression was used to analysis the risk factors for prognosis in the adenocarcinoma of lung.Results(1)EF staining in 123 cases of lung adenocarcinoma,inclouding 60(48.78%),23(18.70%),40(32.52%)cases presenting as EFP Ⅰ,EFP Ⅱ,EFP Ⅲ.The expression of EFPⅠ,EFP Ⅱ and EFP Ⅲ in AIS were 8.57%,22.86%and 68.57%,and those in invasive lung adenocarcinoma were 64.77%,17.05%and 18.18%.The expression level of EFP Ⅱ and EFP Ⅲ in AIS was significantly higher than that in invasive lung adenocarcinoma,showing significant differences(P<0.05).In invasive adenocarcinoma of lung,the EF grade of low-differentiated adenocarcinoma was significantly higher than that of moderately differentiated adenocarcinoma(P<0.05).The expression of elastic fibers Ⅲgrade in AIS was significantly higher than that in low grade adenocarcinoma(P<0.05)The different level of EF was not associated to the age and sex of patients(P>0.05).The analysis showed that the different level of EF was associated with tumor diameter and lymph levels(P<0.05).(2)EF analysis results:In 123 cases of lung adenocarcinoma,the overall survival rate of patients with EFP Ⅲ was significantly higher than EFP Ⅰ and EFP Ⅱ.Three different levels in the EF survival rate was EFP I(60.00%),EFP Ⅱ(79.30%),EFPⅢ(95.00%),showing significant differences(P<0.05).The diameter of tumor and lymph gland affected the independence of DFS and OS in the adenocarcinoma of lung according to multiply factors analysis.EF level was not the independent factor that affects the adenocarcinoma of lung prognosis.(3)Among 88 cases of invasive lung adenocarcinoma,33 cases were in VPI group,and 55 cases were in PL1 group(n=13)and PL2 group(n=20).The diameter of tumor and lymph levels showing significant differences with VPI(P<0.05).(4)VPI survival analysis:Patients with VPI had significantly lower DFS and OS than those without VPI(P<0.05).There were significant differences in DFS and OS between patients with PL1,PL2 and PL3 groups(P<0.05).According to multify analysis,VPI was the independent dangerours factors on the invasive adenocarcinoma of lung prognosis(DFS:P<0.05,OS:P<0.05),and the group of PL1,PL2 were all the independent dangerours factors on the invasive adenocarcinoma of lung prognosis.Conclusions(1)In the interstitial of lung adenocarcinoma,the EF grade of in situ adenocarcino-ma is significantly higher than that of invasive lung adenocarcinoma.EF staining is valuable in differentiating in situ lung adenocarcinoma from invasive adenocarcinoma.The prognosis of patients with obvious proliferation of EF is better,but EF is not an independent risk factor for prognosis.(2)The levels of VPI in invasive lung adenocarcinoma group are significantly lower than those in NVPI group.VPI is an independent fisk factor for prognosis,and the group of PL1 and PL2 are the independent dangerous factor that affect the prognosis of the invasive lung adenocarcinoma patients.