Measurement of resection volume using computed tomography 3D modeling in lung cancer patients and survival analysis

The prognostic significance of the volumetric extent of lung resection in nonsmall cell lung cancer remains uncertain. Three-dimensional computed tomography allows quantitative assessment of resected lung parenchyma, but the relationship between resection volume ratios and oncologic outcomes has not been clearly established. The aim in this study was to evaluate the prognostic value of three-dimensional computed tomography-derived resection volume ratios for disease-free survival after surgery for nonsmall cell lung cancer.

This single-center retrospective study included 141 patients who underwent anatomical resection with systematic mediastinal lymph node dissection between 2010 and 2021. Resection volume, ipsilateral lung volume, total lung volume, and derived ratios were calculated from preoperative computed tomography images. The early- and advanced-stage subgroups were analyzed separately. Receiver operating characteristic analysis was used when appropriate, whereas median values were used for exploratory survival comparisons when no meaningful threshold was identified. Disease-free survival was evaluated using Kaplan-Meier and Cox's regression analyses.

In the Kaplan-Meier analysis, a higher resection-to-total lung volume ratio was associated with better disease-free survival in early-stage disease (75.6% vs. 53.4%, p = 0.015) but worse disease-free survival in advanced-stage disease (25.0% vs. 47.8%, p = 0.009). In the multivariable continuous Cox's analysis, the resection-to-total lung volume ratio was not independently associated with disease-free survival in the early-stage patients. In contrast, in the advanced-stage patients, each 0.1 increase in this ratio was independently associated with worse disease-free survival (hazard ratio = 4.32, 95% confidence interval: 1.16-16.12, p = 0.029). No independent association was observed in the pooled multivariable model.

The prognostic effect of the resection-to-total lung volume ratio appears to be stage-dependent in nonsmall cell lung cancer. Although favorable unadjusted associations were observed in early-stage disease, these were not confirmed in multivariable continuous analysis. In advanced-stage disease, however, higher values were independently associated with worse disease-free survival.