Prognostic Radiological Tools for Clinical Stage IA Pure Solid Lung Cancer

In this study, we analyzed prognostic radiological tools and surgical outcomes for radiologically pure solid adenocarcinomas (AD) and squamous cell carcinoma (SQ) in clinical stage IA. We retrospectively investigated 130 patients who underwent surgical resections. We assessed the predictive risk factors for recurrence and pathological lymph node metastasis (LNM). There was no statistical difference in recurrence free survival (RFS) or cancer-specific survival (CSS) between AD and SQ groups (p = 0.642 and p = 0.403, respectively). In the whole cohort, tumor size on lung window and mediastinal settings, and tumor disappearance ratio using high-resolution computed tomography (HRCT) were not prognostic parameters (p = 0.127, 0.066, and 0.082, respectively). The maximal standardized uptake value (SUVmax) using positron emission tomography-CT was associated with recurrence (p = 0.016). According to the receiver operating characteristic curve, the cut-off value of SUVmax for recurrence was 4.6 (p = 0.016). The quantitative continuous variables using any radiological tools were not associated with LNM. However, tumor diameter on mediastinal setting ≥8 mm with SUVmax ≥2.4 could be a risk factor for LNM. Pure solid AD and SQ were equivalent for the RFS and CSS. SUVmax was useful to predict recurrence. The tumor diameter on a mediastinal setting and SUVmax were useful in predicting pathological LNM.

Prediction of Myometrial Invasion in Stage I Endometrial Cancer by MRI: The Influence of Surgical Diagnostic Procedure

Young women with endometrial cancer (EC) can choose fertility-sparing treatment for stage 1A disease without myometrial invasion (MI). The surgical diagnostic procedure (SDP) may affect the accuracy of magnetic resonance imaging (MRI) to assess MI. Here, we evaluated different SDP and compared the MI on MRI results with further pathologic results after hysterectomy. We retrospectively collected data on 263 patients with clinical stage IA EC diagnosed between January 2013 and December 2015. Patients were classified into four groups based on SDP, including diagnostic hysteroscopic biopsy (DHB, group 1), operative hysteroscopic partial resection (OHPR, group 2), operative hysteroscopic complete resection (OHCR, group 3), and cervical dilatation and fractional curettage (D&C, group 4). The sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of MRI to assess MI were 73.1%, 46.7%, 63.9%, 71.8%, and 48.3%, respectively. Three hysteroscopic procedures (groups 1 to 3) had a trend with a higher odds ratio of discrepancy between MRI and histopathology (p = 0.068), especially in group 2 (odds ratio 2.268, p = 0.032). Here, we found MRI accuracy of MI was better in patients with EC diagnosed with D&C. Three diagnostic procedures using hysteroscopy might interfere with the diagnostic power of MI on MRI.

Clinical Value of CTR, CEA, Histological Type, Ki-67 and EGFR in Predicting pN in Clinical Stage IA Lung Adenocarcinoma and Nomogram Construction

To investigate the clinical value of CTR, CEA, histological type, Ki-67 and EGFR in detecting pathological lymph node metastasis (pN) in clinical stage IA (cIA) lung adenocarcinoma and to construct a pN Nomogram model. A total of 374 cIA lung adenocarcinoma patients who had undergone thoracoscopic radical resection with Systematic mediastinal lymph node dissection (SMLD) in the Department of Thoracic Surgery of the Affiliated Hospital of Qingdao University between January 2018 to January 2020 were retrospectively reviewed. The patients were divided into pN(+) and pN(-) groups. Univariate and multivariate Logistic regression analyses were used to analyze the independent risk factors of pN in lung cancer patients. The ROC curve was used to compare the accuracy of CTR, CEA and Ki-67 in predicting pN. R software was used to construct a Nomogram prediction model based on multivariate Logistic regression analysis of the pN risk. The C-index was calculated, and a calibration curve was drawn to judge the calibration degree of the model. The preoperative and intraoperative examinations showed that CTR (OR 570.406, P＜0.001), CEA (OR 1.239, P＜0.001) and micropapillary adenocarcinoma (OR 86.712, P＜0.001) were independent risk factors of pN. Immunohistochemical analysis and gene detection showed that Ki-67 index (OR 4.832, P＜0.001) and EGFR mutations, such as exon 19 (OR 10.319, P＜0.001), exon 21 (OR 7.163, P＜0.001) and exon 19+20 mutations (OR 570.406, P＜0.001), were significant factors in predicting pN. CTR, CEA, histological type, Ki-67 index, and EGFR mutations are the predictive factors of pN in cT1a-3aN0M0 lung adenocarcinoma patients. SMLD is recommended to improve patients’ postoperative survival rate when preoperative CTR≥0.775, CEA＞2.52μg/L or intraoperative rapid freezing pathology shows micropapillary components.

Prognostic Impact of Radiological Consolidation Tumor Ratio in Clinical Stage IA Pulmonary Ground Glass Opacities

ObjectivesOur study aimed to validate pathologic findings of ground-glass nodules (GGOs) of different consolidation tumor ratios (CTRs), and to explore whether GGOs could be stratified according to CTR with an increment of 0.25 based on its prognostic role.MethodsWe retrospectively evaluated patients with clinical stage IA GGOs who underwent curative resection between 2011 and 2016. The patients were divided into 4 groups according to CTR step by 0.25. Cumulative survival rates were calculated by the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were conducted to obtain the risk factors on relapse-free survival (RFS). The surv_function of the R package survminer was used to determine the optimal cutoff value. Receiver operating characteristic (ROC) analysis was generated to validate optimal cutoff points of factors.ResultsA total of 862 patients (608 women; median age, 59y) were included, with 442 patients in group A (CTR ≤ 0.25), 210 patients in group B (0.25<CTR ≤ 0.5), 173 patients in group C (0.5<CTR ≤ 0.75), and 37 patients in group D (0.75<CTR<1). The rate of adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) in group A (70.6%) was much higher than other three groups (p<0.001). Multivariable Cox regression revealed that CTR (HR, 1.865; 95%CI, 1.312-2.650; p = 0.001) and lymph node metastasis (HR, 10.407; 95%CI, 1.957-55.343; p = 0.006) were independent prognostic factors for recurrence free survival. In addition, CTR was the only risk factor for the presence of micropapillary or solid pattern (OR=133.9, 95%CI:32.2-556.2, P<0.001) and lymph node metastasis (OR=292498.8, 95%CI:1.2-7.4×1010, P=0.047). Paired comparison showed that rate of presence of micropapillary or solid pattern was highest in group D, followed by group C and group A/B (p<0.001). Lymph node metastasis occurred in group D only (p=0.002).ConclusionsCTR is an independent prognostic factor for clinical stage IA lung adenocarcinoma manifesting as GGO in CT scan. Radiologic cutoffs of CTR 0.50 and 0.75 were able to subdivide patients with different prognosis.

Predicting pathological lymph node status in clinical stage IA peripheral lung adenocarcinoma

OBJECTIVES Even with current diagnostic technology, it is difficult to accurately predict pathological lymph node status (PLNS). This study aimed to develop a prediction model of PLNS in peripheral adenocarcinoma with a dominant solid component, based on clinical and radiological factors on thin-section computed tomography, to identify patients to whom wedge resection or other local therapies could be applied. METHODS Of 811 patients enrolled in a prospective multi-institutional study (JCOG0201), 420 patients with clinical stage IA peripheral lung adenocarcinoma having a dominant solid component were included. Multivariable logistic regression was performed to develop a model based on clinical and centrally reviewed radiological factors. Leave-one-out cross-validation and external validation analyses were performed, using independent data from 221 patients. Sensitivity, specificity and concordance statistics were calculated to evaluate diagnostic performance. RESULTS The formula for calculating the probability of pathological lymph node metastasis included the following variables: tumour diameter (including ground-glass opacity), consolidation-to-tumour ratio and density of solid component. The concordance statistic was 0.8041. When the cut-off value associated with the risk of incorrectly predicting negative pathological lymph node metastasis (pN−) was 4.9%, diagnostic sensitivity and specificity in predicting PLNS were 95.7% and 46.0%, respectively. The concordance statistic for the external validation set was 0.7972, and diagnostic sensitivity and specificity in predicting PLNS were 95.4% and 40.5%, respectively. CONCLUSIONS The proposed model is clinically useful and successfully predicts pN− in patients with clinical stage IA peripheral lung adenocarcinoma with a dominant solid component.