Results of the subgroup analysis.

BackgroundA number of studies have shown that various histological subtypes of lung adenocarcinoma have different clinical prognoses, but the cribriform pattern, as a unique histological subtype, plays an important role in the prognosis of patients with lung adenocarcinoma.ObjectiveIn this meta-analysis, we evaluated the role of the cribriform pattern in the overall survival of patients with lung adenocarcinoma, which may provide valuable information for the treatment of patients with lung adenocarcinoma. This also provides an important basis for dividing the cribriform pattern into a new histological subtype and classifying it.MethodsWe searched the literature from the PubMed, Embase, Cochrane and Web of Science online databases; extracted the data and characteristics of each study; and extracted and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the impact of the cribriform pattern on the prognosis of patients with lung adenocarcinoma.ResultsA total of 10 articles were included in the study according to the preset criteria, with a total of 5487 research subjects. The hazard ratio for the relationship between the cribriform pattern and the overall survival rate of patients with lung adenocarcinoma was 2.05 (95% CI: 1.76–2.39). The prognosis of patients with positive spread through air spaces in the cribriform pattern was significantly worse than that of patients with negative spread through air spaces in the cribriform pattern, with a hazard ratio of 2.58 (95% CI: 1.84–3.62). There was a significant difference in prognosis between patients with the cribriform pattern and those with low-grade and intermediate-grade lung adenocarcinoma, but there was no significant difference in prognosis between patients with the cribriform pattern and those with high-grade lung adenocarcinoma, with hazard ratios of 2.12 (95% CI: 1.12–4.00), 7.70 (95% CI: 2.15–36.20) and 0.96 (95% CI: 0.54–2.40), respectively. Therefore, the cribriform pattern should be used as a histological subtype of high-grade tumors, thus influencing the postoperative prognosis of patients with lung adenocarcinoma.ConclusionThe presence of the cribriform pattern is an independent risk factor for postoperative overall survival in patients with lung adenocarcinoma. The cribriform pattern should be considered a new histological subtype of lung adenocarcinoma and classified with solid carcinoma and micropapillary adenocarcinoma as high-grade tumors.背景 多项研究证实，肺腺癌的各类组织学亚型临床预后存在差异，而筛状结构（cribriform pattern）作为一种独特的组织学亚型，在肺腺癌患者的预后中发挥着重要作用。 目的 本项荟萃分析（meta-analysis）旨在评估筛状结构对肺腺癌患者总生存期（overall survival）的影响，以期为肺腺癌患者的临床治疗提供有价值的参考信息，同时也为将筛状结构确立为新型组织学亚型并进行分类提供重要依据。 方法 本研究检索了PubMed、Embase、Cochrane及Web of Science四大在线数据库的相关文献；提取各项研究的数据与特征，并提取并计算风险比（hazard ratios, HRs）与95%置信区间（confidence intervals, CIs），以评估筛状结构对肺腺癌患者预后的影响。 结果 按照预设标准，本研究共纳入10篇文献，合计纳入5487名研究对象。筛状结构与肺腺癌患者总生存期的关联风险比为2.05（95% CI：1.76–2.39）。伴有气腔播散（spread through air spaces）阳性的筛状结构患者，其预后显著差于筛状结构阴性患者，风险比为2.58（95% CI：1.84–3.62）。筛状结构阳性患者与低级别、中级别肺腺癌患者的预后存在显著差异，但与高级别肺腺癌患者的预后无显著差异，对应的风险比分别为2.12（95% CI：1.12–4.00）、7.70（95% CI：2.15–36.20）及0.96（95% CI：0.54–2.40）。据此，筛状结构应被归类为高级别肿瘤的组织学亚型，进而影响肺腺癌患者的术后预后。 结论 筛状结构的存在是肺腺癌患者术后总生存期的独立危险因素。筛状结构应被视为肺腺癌的新型组织学亚型，并与实性癌（solid carcinoma）和微乳头状腺癌（micropapillary adenocarcinoma）一同归类为高级别肿瘤。