摘要
引言：侵袭性粘液性肺腺癌（IMA）具有独特的影像学表现和病理特征。IMA分为孤立型和肺炎型；然而，目前尚不清楚这些是否在生物学上完全相同。
方法：对2010年1月至2018年12月期间接受肺切除术的70例IMA患者（孤立型[n=38]和肺炎型[n=32]）进行单中心回顾性分析。我们比较了这两种类型的临床和生物学特征。
结果：EGFR、KRAS、BRAF、GNAS、ERBB2、TP53、NRG1和MET等遗传变异的频率没有差异。免疫组织化学显示，MUC1的表达在肺炎型中明显更常见（5.0%对20.0%，p=0.01），在孤立型中弥漫性MUC6阳性（39.0%对13.0%，p>0.02）。我们进一步将孤立型分为有或没有磨玻璃样混浊（GGO）的类型和有或没有疯狂铺砌外观（CPA）的肺炎型，并评估了它们的手术结果。单独型GGO、单独型无GGO、肺炎型无CPA和肺炎型有CPA患者的五年总生存率和无复发生存率分别为95.8%/86.6%、64.3%/70.7%、74.6%/68.9%和50.0%/28.6%。
结论：遗传变异无差异；然而，粘蛋白的表达模式不同。根据孤立型GGO和肺炎型CPA的存在，手术结果不同。这些发现表明，从孤立性IMA到肺炎性IMA呈阶梯式进展。
Abstract
Introduction: Invasive mucinous lung adenocarcinoma (IMA) has unique radiological findings and pathological characteristics. IMA is classified into solitary and pneumonic types; however, it is unclear whether these are biologically identical.
Methods: A single-center retrospective analysis was performed for 70 IMA patients (solitary type [n = 38] and pneumonic type [n = 32]) who underwent pulmonary resection between January 2010 and December 2018. We compared clinical and biological characteristics between the two types.
Results: The frequencies of genetic alternations such as EGFR, KRAS, BRAF, GNAS, ERBB2, TP53, NRG1, and MET were not different. Immunohistochemically, expression of MUC1 was significantly more common in the pneumonic type (5.0% versus 20.0%, p = 0.01) and diffuse MUC6 positive in the solitary type (39.0% versus 13.0%, p = 0.02). We further classified solitary types into those with or without ground-glass opacity (GGO) and pneumonic types into those with or without crazy-paving appearance (CPA), and evaluated their surgical outcomes. Five-year overall survival and relapse free survival rates were 95.8%/86.6%, 64.3%/70.7%, 74.6%/68.9%, and 50.0%/28.6% in patients with solitary type with GGO, solitary type without GGO, pneumonic type without CPA, and pneumonic type with CPA, respectively.
Conclusions: There were no differences in genetic alternations; however, mucin expression pattern was different. Surgical outcomes were different according to the presence of GGO in the solitary type and the presence of CPA in the pneumonic type. These findings suggested a stepwise progression from solitary to pneumonic IMA.
引言：侵袭性粘液性肺腺癌（IMA）具有独特的影像学表现和病理特征。IMA分为孤立型和肺炎型；然而，目前尚不清楚这些是否在生物学上完全相同。
方法：对2010年1月至2018年12月期间接受肺切除术的70例IMA患者（孤立型[n=38]和肺炎型[n=32]）进行单中心回顾性分析。我们比较了这两种类型的临床和生物学特征。
结果：EGFR、KRAS、BRAF、GNAS、ERBB2、TP53、NRG1和MET等遗传变异的频率没有差异。免疫组织化学显示，MUC1的表达在肺炎型中明显更常见（5.0%对20.0%，p=0.01），在孤立型中弥漫性MUC6阳性（39.0%对13.0%，p>0.02）。我们进一步将孤立型分为有或没有磨玻璃样混浊（GGO）的类型和有或没有疯狂铺砌外观（CPA）的肺炎型，并评估了它们的手术结果。单独型GGO、单独型无GGO、肺炎型无CPA和肺炎型有CPA患者的五年总生存率和无复发生存率分别为95.8%/86.6%、64.3%/70.7%、74.6%/68.9%和50.0%/28.6%。
结论：遗传变异无差异；然而，粘蛋白的表达模式不同。根据孤立型GGO和肺炎型CPA的存在，手术结果不同。这些发现表明，从孤立性IMA到肺炎性IMA呈阶梯式进展。
Abstract
Introduction: Invasive mucinous lung adenocarcinoma (IMA) has unique radiological findings and pathological characteristics. IMA is classified into solitary and pneumonic types; however, it is unclear whether these are biologically identical.
Methods: A single-center retrospective analysis was performed for 70 IMA patients (solitary type [n = 38] and pneumonic type [n = 32]) who underwent pulmonary resection between January 2010 and December 2018. We compared clinical and biological characteristics between the two types.
Results: The frequencies of genetic alternations such as EGFR, KRAS, BRAF, GNAS, ERBB2, TP53, NRG1, and MET were not different. Immunohistochemically, expression of MUC1 was significantly more common in the pneumonic type (5.0% versus 20.0%, p = 0.01) and diffuse MUC6 positive in the solitary type (39.0% versus 13.0%, p = 0.02). We further classified solitary types into those with or without ground-glass opacity (GGO) and pneumonic types into those with or without crazy-paving appearance (CPA), and evaluated their surgical outcomes. Five-year overall survival and relapse free survival rates were 95.8%/86.6%, 64.3%/70.7%, 74.6%/68.9%, and 50.0%/28.6% in patients with solitary type with GGO, solitary type without GGO, pneumonic type without CPA, and pneumonic type with CPA, respectively.
Conclusions: There were no differences in genetic alternations; however, mucin expression pattern was different. Surgical outcomes were different according to the presence of GGO in the solitary type and the presence of CPA in the pneumonic type. These findings suggested a stepwise progression from solitary to pneumonic IMA.
