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Published on: February 27, 2020
Prognostic importance of volumetric measurements in stage I lung adenocarcinoma
Masahiro Yanagawa1, Yuko Tanaka, Ann N Leung
1From the Department of Diagnostic Radiology, Stanford University School of Medicine, 1201 Welch Rd, Stanford, CA 94305 (M.Y., A.N.L.); Departments of Radiology (M.Y., T.G., K.U., O.H., H.S., N.T.), Pathology (E.M.), and Respiratory Surgery (S.W.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Radiology, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan (E.M.); Department of Radiology (M.K., H.W.) and Division of Thoracic Surgery (M.I., M.O.), National Cancer Center, Tokyo, Japan; and Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan (T.J.).
Purpose:
To perform volumetric analysis of stage I lung adenocarcinomas by using an automated computer program and to determine value of volumetric computed tomographic (CT) measurements associated with prognostic factors and outcome.
Materials And Methods:
Consecutive patients (n = 145) with stage I lung adenocarcinoma who underwent surgery after preoperative chest CT were enrolled. By using volumetric automated computer-assisted analytic program, nodules were classified into three subgroups: pure ground glass, part solid, or solid. Total tumor volume, solid tumor volume, and percentage of solid volume of each cancer were calculated after eliminating vessel components. One radiologist measured the longest diameter of the solid tumor component and of total tumor with their ratio, which was defined as solid proportion. The value of these quantitative data by examining associations with pathologic prognostic factors and outcome measures (disease-free survival and overall survival) were analyzed with logistic regression and Cox proportional hazards regression models, respectively. Significant parameters identified at univariate analysis were included in the multiple analyses.
Results:
All 22 recurrences occurred in patients with nodules classified as part solid or solid. Multiple logistic regression analysis revealed that percentage of solid volume of 63% or greater was an independent indicator associated with pleural invasion (P = .01). Multiple Cox proportional hazards regression analysis revealed that percentage of solid volume of 63% or greater was a significant indicator of lower disease-free survival (hazard ratio, 18.45 [95% confidence interval: 4.34, 78.49]; P < .001). Both solid tumor volume of 1.5 cm(3) or greater and percentage of solid volume of 63% or greater were significant indicators of decreased overall survival (hazard ratio, 5.92 and 9.60, respectively [95% confidence interval: 1.17, 30.33 and 1.17, 78.91, respectively]; P = .034 and .036, respectively).
Conclusion:
Two volumetric measurements (solid volume, ≥1.5 cm(3); percentage of solid volume, ≥63%) were found to be independent indicators associated with increased likelihood of recurrence and/or death in patients with stage I adenocarcinoma.
