Int J Med Sci 2020; 17(13):1871-1878. doi:10.7150/ijms.45002 This issue

Research Paper

New additional scoring formula on the Pathological Features in Stage I Lung Adenocarcinoma Patients: Impact on Survival

Shilei Zhao1, Fengzhou Li1, Xin Guo2, Tao Guo1, Ken-ichi Mizutani2, Sohsuke Yamada2, Chundong Gu1✉, Hidetaka Uramoto3✉

1. Department of Thoracic Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
2. Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kanazawa, Ishikawa, Japan.
3. Department of Thoracic Surgery, Kanazawa Medical University, Kanazawa, Ishikawa, Japan.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Zhao S, Li F, Guo X, Guo T, Mizutani Ki, Yamada S, Gu C, Uramoto H. New additional scoring formula on the Pathological Features in Stage I Lung Adenocarcinoma Patients: Impact on Survival. Int J Med Sci 2020; 17(13):1871-1878. doi:10.7150/ijms.45002. Available from

File import instruction


Background: Histological heterogeneity of lung adenocarcinoma may result in different prognosis among patients with the same TNM pathological stage. However, no objective evaluation system of lung adenocarcinoma based on pathological features has been widely accepted for assessing the prognosis.

Methods: We retrospectively analyzed 179 patients with stage I lung adenocarcinoma after complete surgical resection. The pathological classification was according to the IASLC/ATS/ERS adenocarcinoma classifications, and the detailed abundance ratio using HE staining of primary tumor specimens was recorded. A new additional scoring formula on the pathological features (ASP) was established. The association of the ASP score with the patients' survival was examined.

Results: The ASP scoring was significantly associated with smoking history (p=0.004), lymphatic vessel invasion (p<0.001), vascular invasion, differentiation (p<0.001) and Ki67 (p<0.001). The patients in the high-ASP-score group tended to have vascular invasion (odds ratio [OR]: 1.637, 95% confidence interval [CI]: 1.923-13.745, p=0.001) and high Ki67 expression (OR: 2.625, 95%CI: 1.328-5.190, p=0.006) by logistic regression analyses. The prognosis differed significantly in the Kaplan-Meier survival curves, and the 5-year survival rates in the low and high ASP score groups were 97.8% and 89.6%, respectively (p=0.018). Based on the univariate analysis, female (OR: 0.111, 95%CI: 0.014-0.906, p=0.040), long smoking history (OR: 7.250, 95%CI: 1.452-36.195, p=0.016), poor differentiation characteristics correlation (OR: 12.691, 95%CI: 1.557-103.453, p=0.018), and high ASP score (OR: 5.788, 95%CI: 1.138-29.423, p=0.034) were shown to be independently associated with an unfavorable prognosis.

Conclusion: The ASP score can effectively screen high-risk patients for complete surgical resection of stage I lung adenocarcinoma.

Keywords: Prognosis, Pathological classification, Lung adenocarcinoma, Heterogeneity