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. 2023 Jan 31:13:1103269.
doi: 10.3389/fonc.2023.1103269. eCollection 2023.

Preoperative prognostic prediction for stage I lung adenocarcinomas: Impact of the computed tomography features associated with the new histological grading system

Min Liang  1 , Wei Tang  1 , Fengwei Tan  2 , Hui Zeng  2   3 , Changyuan Guo  4 , Feiyue Feng  2 , Ning Wu  1   5   6
Affiliations

Preoperative prognostic prediction for stage I lung adenocarcinomas: Impact of the computed tomography features associated with the new histological grading system

Min Liang et al. Front Oncol. .

Abstract

Objectives: This study aimed to identify the computed tomography (CT) features associated with the new International Association for the Study of Lung Cancer (IASLC) three-tiered grading system to improve the preoperative prediction of disease-free survival of stage I lung adenocarcinoma patients.

Methods: The study included 379 patients. Ordinal logistic regression analysis was used to identify the independent predictors of IASLC grades. The first multivariate Cox regression model (Model 1) was based on the significant factors from the univariate analysis. The second multivariate model (Model 2) excluded the histologic grade and based only on preoperative factors.

Results: Larger consolidation tumor ratio (OR=2.15, P<.001), whole tumor size (OR=1.74, P=.002), and higher CT value (OR=3.77, P=.001) were independent predictors of higher IASLC grade. Sixty patients experienced recurrences after 70.4 months of follow-up. Model 1 consisted of age (HR:1.05, P=.003), clinical T stage (HR:2.32, P<.001), histologic grade (HR:4.31, P<.001), and burrs sign (HR:5.96, P<.001). Model 2 consisted of age (HR,1.04; P=.015), clinical T stage (HR:2.49, P<.001), consolidation tumor ratio (HR:2.49, P=.016), whole tumor size (HR:2.81, P=.022), and the burrs sign (HR:4.55, P=.002). Model 1 had the best prognostic predictive performance, followed by Model 2, clinical T stage, and histologic grade.

Conclusion: CTR (cut-off values of <25% and ≥75%) and whole tumor size (cut-off value of 17 mm) could stratify patients into different prognosis and be used as preoperative surrogates for the IASLC grading system. Integrating these CT features with clinical T staging can improve the preoperative prognostic prediction for stage I lung adenocarcinoma patients.

Keywords: IASLC grading system; clinical T stage; invasive lung adenocarcinoma; preoperative CT imaging; prognostic model.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient selection and study procedure. LUAD, lung adenocarcinoma; DFS, disease-free survival; GGN, ground glass nodule.
Figure 2
Figure 2
The ROC curves of CTR, mean CT value and whole tumor size (mean diameter) alone and combination for predicting histologic grade 3. ROC, receiver operating characteristic; CTR, consolidation tumor ratio.
Figure 3
Figure 3
Kaplan-Meier estimates of DFS. DFS curves according to CT values (A), whole tumor size (B), 6-category CTR (C), 3-category CTR (D), histologic grade (E), and clinical T stage (F). DFS, disease-free survival; CTR, consolidation tumor ratio.
Figure 4
Figure 4
The nomogram models for predicting DFS for patients with pathological stage I LUAD and the C-index estimates over time. Model-1 (A) and Model-2 (B) for predicting the 1-, 3‐ and 5‐year DFS rates. (C) The time‐dependent C‐index of model 1, model 2, clinical T stage and histologic grade. DFS, disease-free survival; LUAD, lung adenocarcinoma.
Figure 5
Figure 5
The calibration plots for evaluating the nomogram models. The calibration curves of Model 1 (A) and Model 2 (B) for predicting the 3‐ and 5‐year DFS.
Figure 6
Figure 6
DCA curves of Model 1, Model 2, clinical T stage, and histologic grade in predicting 3-year and 5-year DFS. DCA, decision curve analysis.
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References

    1. Kris MG, Gaspar LE, Chaft JE, Kennedy EB, Azzoli CG, Ellis PM, et al. . Adjuvant systemic therapy and adjuvant radiation therapy for stage I to IIIA completely resected non-Small-Cell lung cancers: American society of clinical Oncology/Cancer care Ontario clinical practice guideline update. J Clin Oncol (2017) 35:2960–74. doi: 10.1200/jco.2017.72.4401 - DOI - PubMed
    1. Pisters K, Kris MG, Gaspar LE, Ismaila N. Adjuvant systemic therapy and adjuvant radiation therapy for stage I-IIIA completely resected non-Small-Cell lung cancer: ASCO guideline rapid recommendation update. J Clin Oncol (2022) 40:1127–9. doi: 10.1200/jco.22.00051 - DOI - PubMed
    1. Okami J, Shintani Y, Okumura M, Ito H, Ohtsuka T, Toyooka S, et al. . Demographics, safety and quality, and prognostic information in both the seventh and eighth editions of the TNM classification in 18,973 surgical cases of the Japanese joint committee of lung cancer registry database in 2010. J Thorac Oncol (2019) 14:212–22. doi: 10.1016/j.jtho.2018.10.002 - DOI - PubMed
    1. Wang Y, Zheng D, Luo J, Zhang J, Pompili C, Ujiie H, et al. . Risk stratification model for patients with stage I invasive lung adenocarcinoma based on clinical and pathological predictors. Transl Lung Cancer Res (2021) 10:2205–17. doi: 10.21037/tlcr-21-393 - DOI - PMC - PubMed
    1. Huang W, Zhang H, Zhang Z, Zhang B, Sun X, Huo Y, et al. . A prognostic nomogram based on a new classification of combined micropapillary and solid components for stage IA invasive lung adenocarcinoma. J Surg Oncol (2022) 125:796–808. doi: 10.1002/jso.26760 - DOI - PubMed

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