The Relationship Between Pulmonary Spiculation and Central Fibrosis, Along With Other Clinicopathological Features,...

Spiculation is a critical radiological feature in invasive adenocarcinoma (IAC). This study explores its pathological association with central fibrosis subtypes to refine prognostic evaluation.

A total of 327 cases of IAC were divided into spiculated (n = 158) and non-spiculated (n = 169) groups. Associations between spiculation, central fibrosis, intratumoral fibrosis, and other factors were analyzed. Multivariate logistic regression was used to identify contributors to spiculation formation. Survival was assessed using Kaplan-Meier curves and Cox regression. Propensity score matching (PSM) was utilized to minimize confounding variables.

The spiculated group showed higher rates of pleural indentation, central fibrosis > 5 mm, and increased intratumoral fibrosis, collagen content in both the original and matched cohorts (all p < 0.05), while spiculation was associated with elastin content in the original cohort (p = 0.020), this correlation disappeared after PSM. Multivariate logistic regression identified central fibrosis, collagen content, pleural indentation, tumor size, and lymph node metastasis as independent predictors of spiculation. Spiculation was associated with poorer survival in the original cohort (p < 0.001), but this significance disappeared after PSM (p = 0.860). In Cox analysis, spiculation was not an independent prognostic factor. Alveolar collapse > 5 mm was an independent protective factor, while intratumoral fibrosis and lymph node metastasis were adverse prognostic factors.

Spiculation is closely associated with central fibrosis. It shows a stronger correlation with collagen content than with elastin content. While reflecting underlying aggressiveness, spiculation lacks independent prognostic value. Integrating spiculation with central fibrosis is essential for precise risk stratification.