Abstract
IntroductionStage IA lung adenocarcinoma manifested as part-solid nodules (PSNs), has attracted immense attention owing to its unique characteristics and the definition of its invasiveness remains unclear. We sought to develop a nomogram for predicting the status of lymph nodes of this kind of nodules.MethodsA total of 2,504 patients between September 2018 to October 2020 with part-solid nodules in our center were reviewed. Their histopathological features were extracted from paraffin sections, whereas frozen sections were reviewed to confirm the consistency of frozen sections and paraffin sections. Univariate and multivariate logistic regression analyses and Akaike information criterion (AIC) variable selection were performed to assess the risk factors of lymph node metastasis and construct the nomogram. The nomogram was subjected to bootstrap internal validation and external validation. The concordance index (C-index) was applied to evaluate the predictive accuracy and discriminative ability.ResultsWe enrolled 215 and 161 eligible patients in the training cohort and validation cohort, respectively. The sensitivity between frozen and paraffin sections on the presence of micropapillary/solid subtype was 78.4%. Multivariable analysis demonstrated that MVI, the presence of micropapillary/solid subtype, and CTR >0.61 were independently associated with lymph node metastasis (p < 0.01). Five risk factors were integrated into the nomogram. The nomogram demonstrated good accuracy in estimating the risk of lymph node metastasis, with a C-index of 0.945 (95% CI: 0.916–0.974) in the training cohort and a C-index of 0.975 (95% CI: 0.954–0.995) in the validation cohort. The model’s calibration was excellent in both cohorts.ConclusionThe nomogram established showed excellent discrimination and calibration and could predict the status of lymph nodes for patients with ≤3 cm PSNs. Also, this prediction model has the prediction potential before the end of surgery.
Highlights
Stage IA lung adenocarcinoma manifested as part-solid nodules (PSNs), has attracted immense attention owing to its unique characteristics and the definition of its invasiveness remains unclear
Eligible patients enrolled between October 2018 and September 2019 constituted a training cohort for developing the nomogram, whereas those enrolled between October 2019 and September 2020 formed the validation cohort
We studied 376 consecutive patients with cStageT1a-cN0 lung invasive adenocarcinoma
Summary
Stage IA lung adenocarcinoma manifested as part-solid nodules (PSNs), has attracted immense attention owing to its unique characteristics and the definition of its invasiveness remains unclear. Kenji et al [5] claimed that CTR could predict invasiveness of part-solid nodules (≤2 cm), whereas nodules with CTR 80% were more prone to lymph node metastasis, and their disease-free survival (DFS) and overall survival (OS) were significantly lower than that of patients with CTR ≤80% [4] They suggested a clear definition of the upper limit of the solid component of PSNs
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