Histologic Assessment of Non–Small Cell Lung Carcinoma after Neoadjuvant Therapy

Abstract

Chemotherapy or chemoradiation is often used in Stage IIIA non-small cell lung carcinoma before surgical resection (neoadjuvant therapy). In reviewing the histopathology of such tumors after resection, the recognition that the pathologic changes are related to prior therapy and the assessment of tumor regression are both of importance. To refine histologic parameters for tumor regression and describe patterns of tumor reaction to therapy, we identified 30 lobectomy or pneumonectomy specimens from 1996-2000 in which neoadjuvant therapy was received before surgical resection. Histologic patterns of treatment-induced tumor regression were analyzed semiquantitatively and included necrosis, fibrosis, mixed inflammatory infiltrate, foamy macrophages, and giant cells. To identify clinical and histologic parameters that correlate with treatment response, the 30 specimens were graded for tumor regression. No correlation was found between tumor regression and age, gender, or type of therapy (chemoradiation versus chemotherapy alone). Squamous cell carcinoma showed a significantly higher rate of response than adenocarcinoma (P =.04), with a significant number of adenocarcinomas in the nonresponder subgroup (P =.05). Tumor size reduction by radiologic assessment, when compared with histologic regression, did not reveal a statistically significant association. However, a positive correlation was found between extent of fibrosis and radiologic estimate of size reduction.

Histologic features of low- and intermediate-grade neuroendocrine carcinoma (typical and atypical carcinoid tumors) of the lung

“…It has been reported that hemorrhage, psammoma bodies, and/or cholesterol cleft form after the degeneration and disappearance of tumor cells [18][19][20]. However, we found that these factors were not associated with the patients' clinical outcomes in our study.…”

The Wilms’ tumour suppressor Wt1 is a major regulator of tumour angiogenesis and progression

“…After 4 weeks, we observed a combination of reduced tumour volume, lower tumour cell number, strong lymphocytic cell infiltration (arrowheads in Fig. 2e), concentric fibrosis and central necrosis as signs of tumour regression 21,22 in Tie2-CreERT2;Wt1 lox/lox þ tamoxifen animals. No signs of regression could be noticed in the control groups (Fig.…”

Predictive factors for survival in stage IIIA N2 NSCLC patients treated with neoadjuvant CCRT followed by surgery

“…For patients receiving neoadjuvant chemotherapy (CTx) or CCRT for locally advanced NSCLC, there is abundant information on histopathologic factors establishing their role in the prediction of tumor response and patient survival [6,7,[10][11][12][13][14][15][16][17][18][19]. In contrast, the predictive value of imaging factors after neoadjuvant therapy for patients' OS and recurrence is still controversial and has been discussed in only a few studies [20][21][22].…”