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A Novel Tumor Burden Index to Predict the Prognosis in Stage IA Lung Adenocarcinoma
Shangshang Ma1, Xichun Qin1, Xinjie Xia1
1Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Background:
This study aimed to evaluate the prognostic utility of a novel tumor burden index (TBI) for patients with pathologic stage IA lung adenocarcinoma after complete resection.
Methods:
This study retrospectively analyzed 994 patients with stage IA lung adenocarcinoma who underwent preoperative chest computed tomography (CT) and curative resection. The TBI was derived from radiologic evaluation. Survival outcomes were assessed using Kaplan-Meier estimates and Cox proportional hazards models.
Results:
During a median follow-up period of 60.6 months, 13.6% of the patients experienced recurrence. Multivariable analysis identified TBI, predominant histologic subtype, surgery extent, spread through air spaces (STAS), and consolidation-to-tumor ratio (CTR) as independent predictors of recurrence-free survival (RFS). Optimal TBI cutoffs of 1.6 and 8.0 stratified patients into three distinct prognostic groups with significantly different RFS and overall survival rates. The TBI demonstrated superior prognostic discrimination compared with tumor diameter or volume. Subgroup analysis showed that for patients with low TBI, sublobar resection achieved RFS comparable with lobectomy, whereas anatomic resection provided outcomes superior to those of wedge resection in the intermediate- and high-TBI groups (segmentectomy vs. wedge resection: hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.14-0.89; P = 0.027; lobectomy vs. wedge resection: HR, 0.34; 95% CI 0.17-0.67; P = 0.002).
Conclusions:
The novel TBI is a robust prognostic marker in stage IA lung adenocarcinoma and may inform personalized surgical strategy based on individualized risk assessment.