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Implication of total tumor size on the prognosis of patients with clinical stage IA lung adenocarcinomas appearing as part-solid nodules: Does only the solid portion size matter?

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Abstract

Objectives

The aim was to investigate the effect of clinico-radiologic variables, including total tumor (Ttotal) size and clinical T category, on the prognosis of patients with stage IA (T1N0M0) lung adenocarcinomas appearing as part-solid nodules (PSNs).

Methods

This institutional review board-approved retrospective study included 506 patients (male:female = 200:306; median age, 62 years) with PSNs of the adenocarcinoma spectrum in clinical stage IA who underwent standard lobectomy at a single tertiary medical center. Prognostic stratification of the patients in terms of disease-free survival was analyzed with variables including age, sex, Ttotal size, solid portion size, clinical T category, and tumor location using univariate and subsequent multivariate Cox regression analysis. Subgroup analysis was performed to reveal the effect of the Ttotal size at each clinical T category.

Results

Multivariate Cox regression analysis demonstrated that Ttotal size*cT1b [interaction term; hazard ratio (HR) = 1.091; 95% confidence interval (CI): 1.015, 1.173; p = 0.019] and cT1c (HR = 68.436; 95% CI: 2.797, 1674.415; p = 0.010) were independent risk factors for the tumor recurrence. When patients with cT1b were dichotomized based on a Ttotal size cutoff of 3.0 cm, PSNs with Ttotal > 3.0 cm showed a significantly worse outcome (HR = 3.796; 95% CI: 1.006, 14.317; p = 0.049). No significant difference was observed in the probability of recurrence between cT1b with Ttotal > 3.0 cm and cT1c (p = 0.915).

Conclusions

Ttotal size is a significant prognostic factor in adenocarcinoma patients in cT1b without lymph node or distant metastasis. PSNs in cT1b with Ttotal > 3.0 cm have a comparable risk of lung cancer recurrence to those in cT1c.

Key Points

• Current T descriptor was a powerful prognostic factor in stage IA adenocarcinomas appearing as part-solid nodules.

• Total tumor size further stratified risk of recurrence of adenocarcinomas in cT1b.

• Upstaging of tumors in cT1b with total tumor size > 3.0 cm may be more appropriate.

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Abbreviations

AIS:

Adenocarcinoma-in-situ

CTR:

Consolidation-to-tumor ratio

DFS:

Disease-free survival

HU:

Hounsfield unit

IQR:

Interquartile range

MIA:

Minimally invasive adenocarcinoma

PSN:

Part-solid nodule

SSN:

Subsolid nodule

Ttotal :

Total tumor

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Acknowledgements

We sincerely express our gratitude to Sunkyung Jeon, Jong Hyuk Lee, Su Yeon Ahn, Roh-Eul Yoo, Hyun-ju Lim, Juil Park, and Woo Hyeon Lim for their help in data acquisition.

Funding

This study has received funding by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (1520230).

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Hyungjin Kim, Jin Mo Goo, Young Joo Suh & Chang Min Park

  2. Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Jin Mo Goo, Chang Min Park & Young Tae Kim

  3. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Young Joo Suh

  4. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Young Tae Kim

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  1. Hyungjin Kim
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Correspondence to Jin Mo Goo.

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Guarantor

The scientific guarantor of this publication is Jin Mo Goo.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was waived by the Institutional Review Board.

Ethical Approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in journal articles (Eur Radiol 2016 26:4465-4474; Eur J Radiol 2016 85:1174-1180; Eur Radiol 2017 27:3266-3274; Eur Radiol 2018 28:2124-2133; Eur Radiol 2017 27:1369-1376).

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Kim, H., Goo, J.M., Suh, Y.J. et al. Implication of total tumor size on the prognosis of patients with clinical stage IA lung adenocarcinomas appearing as part-solid nodules: Does only the solid portion size matter?. Eur Radiol 29, 1586–1594 (2019). https://doi.org/10.1007/s00330-018-5685-7

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  • DOI: https://doi.org/10.1007/s00330-018-5685-7

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