Abstract
BackgroundPreoperative tumor invasiveness in clinical stage T1N0M0 lung adenocarcinoma is critical for optimal surgical procedure. The aim of the present study was to evaluate the relationship between the ground-glass opacity component (GGOc) / solid component (Sc) proportion measured using three-dimensional (3D) computer-quantified computer tomography (CT) number analysis to explore radiographic features for invasiveness prediction in cT1N0M0 lung adenocarcinomas.MethodsA total of 375 surgically resected cT1N0M0 lung adenocarcinoma patients were included. The relativity between the GGOc/Sc proportion and lepidic growth pattern percentage was assessed using Spearman’s rank analysis. Multiple logistic regression analysis was used to determine independent factors from radiographic features for tumor invasiveness. Prediction probability for tumor invasiveness was analysed using a receiver operating characteristic curve (ROC).ResultsWe found that the GGOc proportion was positively correlated with lepidic growth pattern percentage (r = 0.67, P < 0.01), while the Sc proportion was negatively correlated with it (r = − 0.74, P < 0.01). Multivariate analysis showed that tumor size and Sc proportion were identified as independent predictors for tumor invasiveness. The area under the ROC curve (AUC) of Sc proportion was 0.875, which was higher than that of tumor size (0.750) (P < 0.001), and had no significant difference with that of combination of these two factors (0.884) (P = 0.28).ConclusionsThe GGOc/Sc proportion measured using 3D computer-quantified CT number analysis reflects the lepidic growth pattern percentage in tumors, and the Sc proportion may be an important factor for the prediction of tumor invasiveness in cT1N0M0 lung adenocarcinoma.
Highlights
Preoperative tumor invasiveness in clinical stage T1N0M0 lung adenocarcinoma is critical for optimal surgical procedure
The role of limited resection awaits the results of two randomized trials (JCOG 0802 in Japan and CALGB 140503 in North America) [8, 9], previous studies have suggested that sublobar resection alone without adjuvant therapy is the optimal choice for adenocarcinoma in situ (AIS)/minimally invasive adenocarcinoma (MIA) because of the satisfactory prognosis, and some of the cases involved multiple primary adenocarcinoma [10, 11]
The following inclusion criteria were considered for the present study: (a) single adenocarcinomas (3 cm or less in diameter at CT image) with no evidence of malignant satellite nodules and no hilar or mediastinal lymphadenopathy on imaging study or at mediastinoscopy, (b) first treatment with surgery alone, (c) either chest high-resolution computer tomography (HRCT) studies or integrated 18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT acquired within 1 month for preoperative staging before resection, and (d) both pathological sections and clinical data are available for review
Summary
Preoperative tumor invasiveness in clinical stage T1N0M0 lung adenocarcinoma is critical for optimal surgical procedure. The role of limited resection awaits the results of two randomized trials (JCOG 0802 in Japan and CALGB 140503 in North America) [8, 9], previous studies have suggested that sublobar (limited) resection alone without adjuvant therapy is the optimal choice for AIS/MIA because of the satisfactory prognosis, and some of the cases involved multiple primary adenocarcinoma [10, 11]. Invasive adenocarcinoma may need lobectomy and adjuvant therapy according to its pathological subtypes and other clinicopathological factors [3]. Pre- or intraoperative diagnosis is critical to select an optimal surgical procedure. Preoperative radiography is necessary and important to help predict tumor invasiveness and determine the most appropriate surgical procedures
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