Clinicopathological and Computed Tomography Features Associated with Recurrence-free Survival of Patients with Small-sized Peripheral Invasive Lung Adenocarcinoma After Sublobectomy

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2023 Dec 18

PMID 38106273

Authors

Jiwen Huo

Tianyou Luo

Fajin Lv

Qi Li

Affiliations

Soon will be listed here.

Abstract

Background: Sublobar resection is gradually becoming a standard treatment for small-sized (≤2 cm) peripheral non-small cell lung cancer (NSCLC), with lung adenocarcinoma (LADC) being the most frequent histologic subtype. However, the prognostic predictors for preoperatively determining whether sublobectomy is feasible for patients with early LADC have not yet been well identified. Therefore, this study aimed to investigate the clinicopathological and computed tomography (CT) features associated with the recurrence-free survival (RFS) of patients with small-sized invasive LADC (SILADC) after sublobar resection.

Methods: This retrospective cohort study analyzed 107 patients with SILADC who underwent preoperative chest CT scan and sublobar resection from December 2012 to March 2019. The Kaplan-Meier survival was used to analyze the relationship between clinicopathological characteristics, preoperative chest CT findings, and RFS. The Cox proportional hazards regression was used to identify independent prognostic factors of poor RFS.

Results: For clinicopathological characteristics, RFS was shorter in patients aged ≥70 years, smokers, and those with micropapillary/solid-predominant adenocarcinomas (all P values <0.05). For preoperative CT features, RFS was shorter in patients with tumor size ≥1.4 cm, solid component size ≥1.1 cm, proportion of solid component ≥72%, solid density, spiculation, vascular convergence sign, peripheral fibrosis, and type II pleural tag (all P values <0.05). Multivariate analysis showed proportion of solid component ≥72% [hazard ratio (HR): 5.920; P=0.006; 95% confidence interval (CI): 1.686-20.794], spiculation (HR: 5.026; P=0.001; 95% CI: 2.008-12.581), and type II pleural tag (HR: 4.638; P=0.002; 95% CI: 1.773-12.136) were independent risk factors for poor prognosis in patients with SILADC after sub-lobectomy.

Conclusions: Clinicopathological and CT characteristics are helpful for predicting the RFS of patients with SILADC after sublobar resection and can be used as an auxiliary tool for thoracic surgeons to choose the best surgical mode.

References

Huo J, Huang X, Li X, Gong J, Luo T, Li Q . Pneumonic-type lung adenocarcinoma with different ranges exhibiting different clinical, imaging, and pathological characteristics. Insights Imaging. 2021; 12(1):169. PMC: 8599601. DOI: 10.1186/s13244-021-01114-2. View

Nomori H, Horio H, NARUKE T, Suemasu K . What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery?. Ann Thorac Surg. 2001; 72(3):879-84. DOI: 10.1016/s0003-4975(01)02891-0. View

de Koning H, van der Aalst C, de Jong P, Scholten E, Nackaerts K, Heuvelmans M . Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020; 382(6):503-513. DOI: 10.1056/NEJMoa1911793. View

Hiramatsu M, Inagaki T, Inagaki T, Matsui Y, Satoh Y, Okumura S . Pulmonary ground-glass opacity (GGO) lesions-large size and a history of lung cancer are risk factors for growth. J Thorac Oncol. 2008; 3(11):1245-50. DOI: 10.1097/JTO.0b013e318189f526. View

Hsu J, Han I, Tsai T, Lin S, Jaw T, Liu G . Pleural Tags on CT Scans to Predict Visceral Pleural Invasion of Non-Small Cell Lung Cancer That Does Not Abut the Pleura. Radiology. 2015; 279(2):590-6. DOI: 10.1148/radiol.2015151120. View

Moon Y, Sung S, Moon S, Park J . Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography. J Thorac Dis. 2016; 8(8):2018-26. PMC: 4999695. DOI: 10.21037/jtd.2016.07.90. View

Crino L, Weder W, Van Meerbeeck J, Felip E . Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010; 21 Suppl 5:v103-15. DOI: 10.1093/annonc/mdq207. View

Sawabata N, Kanzaki R, Sakamoto T, Kusumoto H, Kimura T, Nojiri T . Clinical predictor of pre- or minimally invasive pulmonary adenocarcinoma: possibility of sub-classification of clinical T1a. Eur J Cardiothorac Surg. 2013; 45(2):256-61. DOI: 10.1093/ejcts/ezt329. View

Fiorelli A, Caronia F, Daddi N, Loizzi D, Ampollini L, Ardo N . Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients?. Surg Today. 2016; 46(12):1370-1382. DOI: 10.1007/s00595-016-1314-8. View

10.

Lee H, Kim Y, Kang C, Zhao B, Tan Y, Schwartz L . Epidermal growth factor receptor mutation in lung adenocarcinomas: relationship with CT characteristics and histologic subtypes. Radiology. 2013; 268(1):254-64. DOI: 10.1148/radiol.13112553. View

11.

Huang Y, Liu Z, He L, Chen X, Pan D, Ma Z . Radiomics Signature: A Potential Biomarker for the Prediction of Disease-Free Survival in Early-Stage (I or II) Non-Small Cell Lung Cancer. Radiology. 2016; 281(3):947-957. DOI: 10.1148/radiol.2016152234. View

12.

Ma J, Yang Y, Wang Y, Zhang X, Gu X, Wang Z . Relationship between computed tomography morphology and prognosis of patients with stage I non-small cell lung cancer. Onco Targets Ther. 2017; 10:2249-2256. PMC: 5408946. DOI: 10.2147/OTT.S114960. View

13.

Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D . Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023; 388(6):489-498. PMC: 10036605. DOI: 10.1056/NEJMoa2212083. View

14.

Aly R, Rekhtman N, Li X, Takahashi Y, Eguchi T, Tan K . Spread Through Air Spaces (STAS) Is Prognostic in Atypical Carcinoid, Large Cell Neuroendocrine Carcinoma, and Small Cell Carcinoma of the Lung. J Thorac Oncol. 2019; 14(9):1583-1593. PMC: 8160527. DOI: 10.1016/j.jtho.2019.05.009. View

15.

Kuhn E, Morbini P, Cancellieri A, Damiani S, Cavazza A, Comin C . Adenocarcinoma classification: patterns and prognosis. Pathologica. 2018; 110(1):5-11. View

16.

Liu Y, Kim J, Qu F, Liu S, Wang H, Balagurunathan Y . CT Features Associated with Epidermal Growth Factor Receptor Mutation Status in Patients with Lung Adenocarcinoma. Radiology. 2016; 280(1):271-80. PMC: 4934516. DOI: 10.1148/radiol.2016151455. View

17.

Lee M, Kang J, Lee H, Kim W, Shon I, Hwang N . Spread through air spaces (STAS) in invasive mucinous adenocarcinoma of the lung: Incidence, prognostic impact, and prediction based on clinicoradiologic factors. Thorac Cancer. 2020; 11(11):3145-3154. PMC: 7606017. DOI: 10.1111/1759-7714.13632. View

18.

Choe J, Kim M, Yun J, Lee G, Kim Y, Choi S . Sublobar Resection in Stage IA Non-Small Cell Lung Cancer: Role of Preoperative CT Features in Predicting Pathologic Lymphovascular Invasion and Postoperative Recurrence. AJR Am J Roentgenol. 2021; 217(4):871-881. DOI: 10.2214/AJR.21.25618. View

19.

Zhang B, Zhang Y, Ye J, Qiang J . Use of relative CT values to evaluate the invasiveness of pulmonary subsolid nodules in patients with emphysema. Quant Imaging Med Surg. 2021; 11(1):204-214. PMC: 7719921. DOI: 10.21037/qims-19-998. View

20.

Okada S, Hattori A, Matsunaga T, Takamochi K, Oh S, Inoue M . Prognostic value of visceral pleural invasion in pure-solid and part-solid lung cancer patients. Gen Thorac Cardiovasc Surg. 2020; 69(2):303-310. DOI: 10.1007/s11748-020-01470-8. View