Prognostic value of computed tomography morphologic characteristics in stage I non-small-cell lung cancer

In this study, we describe the prognostic value of NSCLC morphologic characteristics obtainable by computed tomography (CT) in the preoperative staging. Starting with the initial hypothesis that CT morphologic characteristics of NSCLC have a prognostic value, we conducted a retrospective study that included 194 patients.

All patients underwent surgery because of stage IA or IB non-small-cell lung carcinoma (NSCLC). Surgical procedures were performed in our clinic over the period of 9 years and 8 months starting in June 1996 and ending in February 2006. Preoperative CT scans and clinical data available for each patient were analyzed retrospectively.

Over the study period, 93 patients died. The mean survival time was 78.6 months (95% confidence interval was 72.63-84.57 months). After a 2-year follow-up, 85.57% of patients were alive, but this decreased to 63.9% living patients after 5 years. Morphologic tumor characteristics were obtained by analyzing CT images available for each patient. These CT morphologic characteristics were divided into 5 categories: size, tumor edges, structure, and periphery of the tumor, as well as its relation to visceral pleura. We correlated each of these characteristics to the survival of patients.

We conclude that, within stage I NSCLC, patient survival and disease prognosis vary significantly depending on such morphologic characteristics. This fact is one of the weakest points of the current tumor-node-metastasis (TNM) classification. Along with already-established tumor prognostic attributes such as size and TNM grade, we identified CT morphologic characteristics as powerful additional prognostic factors for NSCLC.