A predictive nomogram for lymph node metastasis in part-solid invasive lung adenocarcinoma: A complement to the IASLC
Zhaoming Gao1,2, Xiaofei Wang1, Tao Zuo1,3
1Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Frontiers in Oncology
|September 1, 2022
Summary
This study identified key preoperative risk factors for lymph node metastasis in part-solid invasive lung adenocarcinoma (PSILA). A new nomogram helps predict metastasis risk, guiding lymph node dissection strategies in lung cancer surgery.
Area of Science:
- Oncology
- Thoracic Surgery
- Pathology
Background:
- The International Association for the Study of Lung Cancer (IASLC) introduced a new grading system for lung adenocarcinoma, but it did not include lymphatic invasion assessment.
- The extent of lymph node dissection for part-solid invasive lung adenocarcinoma (PSILA) remains a subject of debate.
- Identifying preoperative risk factors for lymph node metastasis is crucial for optimizing surgical management of PSILA.
Purpose of the Study:
- To explore preoperative risk factors associated with lymph node metastasis in PSILA.
- To develop a predictive tool for lymph node metastasis in PSILA.
- To provide guidance for intraoperative lymph node dissection strategies in PSILA.
Main Methods:
- Retrospective analysis of clinical data from 960 patients diagnosed with PSILA (stage cN0) between 2018 and 2020.
- Classification of patients according to the novel IASLC grading system.
- Logistic regression analysis to identify independent risk factors for lymph node metastasis and construction of a predictive nomogram.
Main Results:
- Solid part size, bronchial cutoff sign, spiculation, and carbohydrate antigen 199 (CA199) were identified as independent predictors of lymph node metastasis in PSILA.
- A nomogram was developed with high predictive accuracy (AUC=0.858, concordance index=0.857) for preoperative risk assessment.
- A cutoff value of 0.027 for the nomogram suggests the need for systematic lymph node dissection.
Conclusions:
- The novel IASLC grading system is applicable in clinical practice.
- The developed nomogram offers a valuable tool for preoperative prediction of lymph node metastasis in PSILA.
- The nomogram can inform lymph node dissection strategies, potentially improving surgical outcomes for PSILA patients.
