Proposal of a prognostically relevant grading scheme for pulmonary squamous cell carcinoma

Wilko Weichert, Claudia Kossakowski, Alexander Harms, Peter Schirmacher, Thomas Muley, Hendrik Dienemann, Arne Warth

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


Recent studies in lung adenocarcinoma established a clinically relevant histomorphologybased classification. In contrast, no morphological classifiers have yet been implemented into routine diagnostics for lung squamous cell carcinoma (SQCC). However, morphology-based characteristics putatively impacting on survival have been proposed. We analysed a cohort of 541 SQCC patients with complete clinical follow-up data for morphological characteristics (keratinisation, tumour cell budding, size of tumour cell nests, nuclear size and stromal content). Morphological characteristics were correlated with clinical data and patient outcome. Keratinisation, budding, stromal content and tumour cell nest size, but not nuclear size, were associated with distinct clinicopathological characteristics and survival. SQCC patients with keratinisation, small cell nest size, high stromal content and extensive budding had shorter overall survival. A combined grading scheme composed of the two most reliable validated prognostic markers, i.e. budding and nest size, resulted in an age-, stage-and sex-independent prognosticator for overall survival with a hazard ratio of 1.6 for grade 2 tumours and a hazard ratio of 3.7 for grade 3 tumours when compared with grade 1 neoplasms (p<0.001). Morphological characteristics of SQCC have significant prognostic impact and could constitute the basis for a diagnostically relevant future SQCC grading scheme.

Original languageEnglish
Pages (from-to)938-946
Number of pages9
JournalEuropean Respiratory Journal
Issue number3
StatePublished - 1 Mar 2016


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