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The significance of histology in non-small cell lung cancer

1990; Elsevier BV; Volume: 17; Issue: 4 Linguagem: Inglês

10.1016/0305-7372(90)90082-q

1532-1967

Seth A. Rosenthal, Walter J. Curran,

Lung Cancer Research Studies

Perspectives on the significance of histology in lung cancer have changed considerably in recent decades. Early surgical series recognized the importance of histology, and several authors noted that squamous carcinomas carried the most favorable prognosis, small cell carcinomas the worst prognosis, with adenocarcinoma and large cell carcinoma occupying an intermediate position ( 1, 12, 67). S ome institutions reported their data separately for each histologic subtype (6, 56, 57, 71, 72). In recent decades, it has become apparent that the biology, clinical behavior, and therapeutic options for small cell lung carcinoma (SCLC) are distinct ( 11,2 1). Discussion of the significance of histology among the other histologic subtypes, the ‘non-small cell’ lung carcinomas (NSCLC) has, at best, occupied a subordinate role in the literature, and at least one co-operative group no longer attempts to gather and report data by histologic subtype (49). There are difficulties in the reliable histologic classification of NSCLC, and potential for variability exists. Feinstein et al. noted a significant intraand inter-observer variability in histologic classification in a 1970 study, with the largest discordance noted with poorly differentiated specimens (22). Significant inter-observer variability was also noted in a contemporary study by Greenberg et al. (3 l), using the revised 1982 World Health Organization (WHO) classification scheme (99). These potential difficulties in the assignment of histopathologic type must be considered in a critical assessment of the literature regarding the clinical significance of histology in NSCLC. Nonetheless, as biochemical and molecular biological techniques show increasing clinical promise, we would like to re-examine the significance of histology in NSCLC. Recognition and understanding of the biological and clinical differences that exist among the various NSCLC histologies, especially those between the squamous and non-squamous (adenocarcinoma and large cell) tumors, may aid in the development of novel therapeutic strategies.