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Na KJ, Kim YT, Goo JM, Kim H. Clinical Utility of a CT-based AI Prognostic Model for Segmentectomy in Non-Small Cell Lung Cancer. Radiology 2024; 311:e231793. [PMID: 38625008 DOI: 10.1148/radiol.231793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Background Currently, no tool exists for risk stratification in patients undergoing segmentectomy for non-small cell lung cancer (NSCLC). Purpose To develop and validate a deep learning (DL) prognostic model using preoperative CT scans and clinical and radiologic information for risk stratification in patients with clinical stage IA NSCLC undergoing segmentectomy. Materials and Methods In this single-center retrospective study, transfer learning of a pretrained model was performed for survival prediction in patients with clinical stage IA NSCLC who underwent lobectomy from January 2008 to March 2017. The internal set was divided into training, validation, and testing sets based on the assignments from the pretraining set. The model was tested on an independent test set of patients with clinical stage IA NSCLC who underwent segmentectomy from January 2010 to December 2017. Its prognostic performance was analyzed using the time-dependent area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for freedom from recurrence (FFR) at 2 and 4 years and lung cancer-specific survival and overall survival at 4 and 6 years. The model sensitivity and specificity were compared with those of the Japan Clinical Oncology Group (JCOG) eligibility criteria for sublobar resection. Results The pretraining set included 1756 patients. Transfer learning was performed in an internal set of 730 patients (median age, 63 years [IQR, 56-70 years]; 366 male), and the segmentectomy test set included 222 patients (median age, 65 years [IQR, 58-71 years]; 114 male). The model performance for 2-year FFR was as follows: AUC, 0.86 (95% CI: 0.76, 0.96); sensitivity, 87.4% (7.17 of 8.21 patients; 95% CI: 59.4, 100); and specificity, 66.7% (136 of 204 patients; 95% CI: 60.2, 72.8). The model showed higher sensitivity for FFR than the JCOG criteria (87.4% vs 37.6% [3.08 of 8.21 patients], P = .02), with similar specificity. Conclusion The CT-based DL model identified patients at high risk among those with clinical stage IA NSCLC who underwent segmentectomy, outperforming the JCOG criteria. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Kwon Joong Na
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Young Tae Kim
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Jin Mo Goo
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Hyungjin Kim
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
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Lee JH, Choi Y, Hong H, Kim YT, Goo JM, Kim H. Prognostic value of CT-defined ground-glass opacity in early-stage lung adenocarcinomas: a single-center study and meta-analysis. Eur Radiol 2024; 34:1905-1920. [PMID: 37650971 DOI: 10.1007/s00330-023-10160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/23/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES The prognostic value of ground-glass opacity at preoperative chest CT scans in early-stage lung adenocarcinomas is a matter of debate. We aimed to clarify the existing evidence through a single-center, retrospective cohort study and to quantitatively summarize the body of literature by conducting a meta-analysis. METHODS In a retrospective cohort study, patients with clinical stage I lung adenocarcinoma were identified, and the prognostic value of ground-glass opacity was analyzed using multivariable Cox regression. Commercial artificial intelligence software was adopted as the second reader for the presence of ground-glass opacity. The primary end points were freedom from recurrence (FFR) and lung cancer-specific survival (LCSS). In a meta-analysis, we systematically searched Embase and OVID-MEDLINE up to December 30, 2021, for the studies based on the eighth-edition staging system. The pooled hazard ratios (HRs) of solid nodules (i.e., absence of ground-glass opacity) for various end points were calculated with a multi-level random effects model. RESULTS In a cohort of 612 patients, solid nodules were associated with worse outcomes for FFR (adjusted HR, 1.98; 95% CI: 1.17-3.51; p = 0.01) and LCSS (adjusted HR, 1.937; 95% CI: 1.002-4.065; p = 0.049). The artificial intelligence assessment and multiple sensitivity analyses revealed consistent results. The meta-analysis included 13 studies with 12,080 patients. The pooled HR of solid nodules was 2.13 (95% CI: 1.69-2.67; I2 = 30.4%) for overall survival, 2.45 (95% CI: 1.52-3.95; I2 = 0.0%) for FFR, and 2.50 (95% CI: 1.28-4.91; I2 = 30.6%) for recurrence-free survival. CONCLUSIONS The absence of ground-glass opacity in early-stage lung adenocarcinomas is associated with worse postoperative survival. CLINICAL RELEVANCE STATEMENT Early-stage lung adenocarcinomas manifesting as solid nodules at preoperative chest CT, which indicates the absence of ground-glass opacity, were associated with poor postoperative survival. There is room for improvement of the clinical T categorization in the next edition staging system. KEY POINTS • In a retrospective study of 612 patients with stage I lung adenocarcinoma, solid nodules were associated with shorter freedom from recurrence (adjusted hazard ratio [HR], 1.98; p = 0.01) and lung cancer-specific survival (adjusted HR, 1.937; p = 0.049). • Artificial intelligence-assessed solid nodules also showed worse prognosis (adjusted HR for freedom from recurrence, 1.94 [p = 0.01]; adjusted HR for lung cancer-specific survival, 1.93 [p = 0.04]). • In meta-analyses, the solid nodules were associated with shorter freedom from recurrence (HR, 2.45) and shorter overall survival (HR, 2.13).
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Affiliation(s)
- Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Young Tae Kim
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
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Huang S, Zhao M, Li S, Chen T, Zhong Y, Deng J, Xu L, Wu J, Xie X, Wu C, Hou L, She Y, Zheng H, Chen C. Incorporation of the lepidic component as an additional pathological T descriptor for non-small cell lung cancer: Data from 3335 cases of lung adenocarcinoma. Lung Cancer 2024; 189:107472. [PMID: 38320371 DOI: 10.1016/j.lungcan.2024.107472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES The Lepidic Component (LP) identifies a subgroup with an excellent prognosis for lung adenocarcinoma (LUAD). Our research aimed to propose an improved pathological T (pT) stage for LUAD based on LP. MATERIALS AND METHODS Totally, 3335 surgical patients with pathological stage I LUAD were incorporated. Factors affecting survival were investigated by analyzing recurrence-free survival (RFS) and overall survival (OS) using the Kaplan-Meier method and Cox regression analyses. Subgroup analysis based on Lepidic Ratio (LR) was further evaluated. The net benefit from the modified pT category (pTm) was assessed using the Area Under the time-dependent Receiver Operating Curve (AUC), Harrell's Concordance Index (C-index), Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI). RESULTS The presence of LP (LP+) was identified in 1425 (42.7 %) patients, indicating a significantly better RFS (P < 0.001) and OS (P < 0.001) than those without LP, and similar results were reproduced in pT1a-pT2a subcategory (P < 0.050 for all). Multivariable Cox analysis revealed LP+ as an independent prognostic factor for both RFS (HR, 0.622; P < 0.001) and OS (HR, 0.710; P = 0.019). However, lepidic ratio (LR) was not independently associated with both RFS and OS for LP+ patients. The 5-year RFS and OS rates between T1a (LP-) and T1b (LP+), T1b (LP-) and T1c (LP+), and T1b (LP-) and T2a (LP+) were comparable (P > 0.050 for all). After modification, compared with current 8th edition pT stage system (pT8), pTm independently predicted RFS and OS, and AUCs, c-index, NRI, and IDI analysis all demonstrated pTm holds better discrimination performances than pT8 for LUAD prognosis. CONCLUSION LP can be an additional down-staged T descriptor for pathological stage I LUAD and improve the survival predictive performance of reclassification.
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Affiliation(s)
- Shenghao Huang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaofeng Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Zheng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Okubo Y, Yatabe Y. Reply to the Letter to the Editor From He Y et al. J Thorac Oncol 2023; 18:e46-e48. [PMID: 37087120 DOI: 10.1016/j.jtho.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Yu Okubo
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.
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Park S, Lee SM, Choe J, Choi S, Do KH, Seo JB. Recurrence Patterns and Patient Outcomes in Resected Lung Adenocarcinoma Differ according to Ground-Glass Opacity at CT. Radiology 2023; 307:e222422. [PMID: 36943079 DOI: 10.1148/radiol.222422] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background Although lung adenocarcinoma with ground-glass opacity (GGO) is known to have distinct characteristics, limited data exist on whether the recurrence pattern and outcomes in patients with resected lung adenocarcinoma differ according to GGO presence at CT. Purpose To examine recurrence patterns and associations with outcomes in patients with resected lung adenocarcinoma according to GGO at CT. Materials and Methods Patients who underwent CT followed by lobectomy or pneumonectomy for lung adenocarcinoma between July 2010 and December 2017 were retrospectively included. Patients were divided into two groups based on the presence of GGO: GGO adenocarcinoma and solid adenocarcinoma. Recurrence patterns at follow-up CT examinations were investigated and compared between the two groups. The effects of patient grouping on time to recurrence, postrecurrence survival (PRS), and overall survival (OS) were evaluated using Cox regression. Results Of 1019 patients (mean age, 62 years ± 9 [SD]; 520 women), 487 had GGO adenocarcinoma and 532 had solid adenocarcinoma. Recurrences occurred more frequently in patients with solid adenocarcinoma (36.1% [192 of 532 patients]) than in those with GGO adenocarcinoma (16.2% [79 of 487 patients]). Distant metastasis was the most common mode of recurrence in the group with solid adenocarcinoma and all clinical stages. In clinical stage I GGO adenocarcinoma, all regional recurrences appeared as ipsilateral lung metastasis (39.2% [20 of 51]) without regional lymph node metastasis. Brain metastasis was more frequent in patients with clinical stage I solid adenocarcinoma (16.5% [16 of 97 patients]). The presence of GGO was associated with time to recurrence and OS (adjusted hazard ratio [HR], 0.6 [P < .001] for both). Recurrence pattern was an independent risk factor for PRS (adjusted HR, 2.1 for distant metastasis [P < .001] and 3.9 for brain metastasis [P < .001], with local-regional recurrence as the reference). Conclusion Recurrence patterns, time to recurrence, and overall survival differed between patients with and without ground-glass opacity at CT, and recurrence patterns were associated with postrecurrence survival. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Sohee Park
- From the Department of Radiology and Research Institute of Radiology (S.P., S.M.L., J.C., K.H.D., J.B.S.) and Department of Cardiothoracic Surgery (S.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, South Korea
| | - Sang Min Lee
- From the Department of Radiology and Research Institute of Radiology (S.P., S.M.L., J.C., K.H.D., J.B.S.) and Department of Cardiothoracic Surgery (S.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, South Korea
| | - Jooae Choe
- From the Department of Radiology and Research Institute of Radiology (S.P., S.M.L., J.C., K.H.D., J.B.S.) and Department of Cardiothoracic Surgery (S.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, South Korea
| | - Sehoon Choi
- From the Department of Radiology and Research Institute of Radiology (S.P., S.M.L., J.C., K.H.D., J.B.S.) and Department of Cardiothoracic Surgery (S.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, South Korea
| | - Kyung-Hyun Do
- From the Department of Radiology and Research Institute of Radiology (S.P., S.M.L., J.C., K.H.D., J.B.S.) and Department of Cardiothoracic Surgery (S.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, South Korea
| | - Joon Beom Seo
- From the Department of Radiology and Research Institute of Radiology (S.P., S.M.L., J.C., K.H.D., J.B.S.) and Department of Cardiothoracic Surgery (S.C.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, South Korea
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Fu F, Tao X, Jiang Z, Gao Z, Zhao Y, Li Y, Hu H, Shen L, Sun Y, Zhang Y. Identification of Germline Mutations in East-Asian Young Never-Smokers with Lung Adenocarcinoma by Whole-Exome Sequencing. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:182-189. [PMID: 37197646 PMCID: PMC10110802 DOI: 10.1007/s43657-022-00062-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 05/19/2023]
Abstract
Recently, an increasing number of young never-smokers are diagnosed with lung cancer. The aim of this study is to investigate the genetic predisposition of lung cancer in these patients and discover candidate pathogenic variants for lung adenocarcinoma in young never-smokers. Peripheral blood was collected from 123 never-smoking east-Asian patients diagnosed with lung adenocarcinoma before the age of 40. Whole-exome sequencing (WES) was conducted on genomic DNA extracted from peripheral blood cells. As a result, 3,481 single nucleotide variants were identified. By bioinformatical tools and the published gene list associated with genetic predisposition of cancer, pathogenic variants were detected in ten germline genes: ATR, FANCD2, FANCE, GATA2, HFE, MSH2, PDGFRA, PMS2, SDHB, and WAS. Patients with pathogenic variants were more likely to occur in females (9/10, 90.0%) and have stage IV lung adenocarcinoma (4/10, 40%). Furthermore, germline mutations in 17 genes (ASB18, B3GALT5, CLEC4F, COL6A6, CYP4B1, C6orf132, EXO1, GATA4, HCK, KCP, NPHP4, PIGX, PPIL2, PPP1R3G, RRBP1, SALL4, and TTC28), which occurred in at least two patients, displayed potentially pathogenic effects. Gene ontology analysis further showed that these genes with germline mutations were mainly located in nucleoplasm and associated with DNA repair-related biological processes. The study provides spectrum of pathogenic variants and functional explanation for genetic predisposition of lung adenocarcinoma in young never-smokers, which sheds a light on prevention and early diagnosis of lung cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-022-00062-1.
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Affiliation(s)
- Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Xiaoting Tao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Zhonglin Jiang
- Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031 China
| | - Zhendong Gao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Yue Zhao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China
| | - Hong Hu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Libing Shen
- International Human Phenome Institutes (Shanghai), Shanghai, 200433 China
| | - Yihua Sun
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032 China
- Institute of Thoracic Oncology, Fudan University, Shanghai, 200032 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
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Liang M, Tang W, Tan F, Zeng H, Guo C, Feng F, Wu N. Preoperative prognostic prediction for stage I lung adenocarcinomas: Impact of the computed tomography features associated with the new histological grading system. Front Oncol 2023; 13:1103269. [PMID: 36798818 PMCID: PMC9927203 DOI: 10.3389/fonc.2023.1103269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
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.
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Affiliation(s)
- Min Liang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zeng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Immunology and National Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyuan Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiyue Feng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Nuclear Medicine (PET-CT Center), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China,*Correspondence: Ning Wu,
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Hattori A, Matsunaga T, Fukui M, Suzuki K, Takamochi K, Suzuki K. Prognostic Impact of Very Small Ground-Glass Opacity Component in Stage IA Solid Predominant Non-small Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2022; 36:251-260. [PMID: 36180013 DOI: 10.1053/j.semtcvs.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
Abstract
We evaluated the prognostic role of the presence of a very small ground glass opacity (GGO) component in stage IA solid-predominant non-small cell lung cancer (NSCLC). We evaluated surgically resected 1471 patients diagnosed with stage IA solid-predominant NSCLC. They were classified into 3 groups; that is, GGO group (0.5
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Nakada T, Yabe M, Ohtsuka T. Efficacy of a combined tool for stage I non‑small cell lung cancer against lymph node metastasis. Oncol Lett 2022; 24:332. [PMID: 36039061 PMCID: PMC9404702 DOI: 10.3892/ol.2022.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
In patients with clinical stage I non-small cell lung cancer (NSCLC), the prediction of occult lymph node metastasis (LNM) based on a combination of morphology using high-resolution computed tomography (HRCT) and metabolism using positron emission tomography (PET)-CT is unknown. The present study evaluated the use of predictive radiological tools, chest CT and PET-CT, for occult LNM in patients with clinical stage I NSCLC. The records of patients who underwent lobectomy between July 2014 and November 2021 were retrospectively reviewed. The differences in clinicopathological parameters, including CT and PET, between the LNM and non-LNM groups were assessed. Pure solid tumor was defined as a consolidation-to-tumor ratio of 1. The optimal cut-off value for predictive radiological tools for LNM was assessed according to the area under the receiver operating characteristic (ROC) curve. The present study included 288 patients, of whom 39 (13.5%) had LNM; of these 38 (97.4%) were pure solid type. Larger consolidation size (CS), higher maximal standardized uptake (SUVmax) value and histological type were statistically associated with LNM (all P<0.05). The optimal cutoff values of CS and SUVmax for predicting LNM were 19 mm and 5.5 respectively, as assessed using the area under the ROC curve. The combination of CS ≥19 mm and SUVmax ≥5.5 demonstrated a markedly higher odds ratio (9.184; 95% CI, 4.345-19.407) than each parameter individually. The minimum values of CS and SUVmax associated with LNM were 10 mm and 0.8 respectively. Pure solid formation and CS as morphology and SUVmax as metabolism were useful tools that complemented each other in predicting LNM. The combined method of evaluating SUVmax and CS may identify eligibility for LN dissection. However, considering the minimum values of CS and SUVmax in LNM, it cannot affirm the omission of LN dissection for cases that do not meet the combined criteria using HRCT and PET-CT.
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Affiliation(s)
- Takeo Nakada
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105‑8471, Japan
| | - Mitsuo Yabe
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105‑8471, Japan
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105‑8471, Japan
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10
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Mao W, Cai Y, Chen D, Jiang G, Xu Y, Chen R, Wang F, Wang X, Zheng M, Zhao X, Mei J. Statin shapes inflamed tumor microenvironment and enhances immune checkpoint blockade in non-small cell lung cancer. JCI Insight 2022; 7:161940. [PMID: 35943796 DOI: 10.1172/jci.insight.161940] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Immune checkpoint blockade (ICB) therapy has achieved breakthroughs in the treatment of advanced non-small cell lung cancer (NSCLC). Nevertheless, the low response due to immuno-cold tumor microenvironment (TME) largely limits the application of ICB therapy. Based on the glycolytic/cholesterol synthesis axis, a stratification framework for EGFR wild-type NSCLC was developed to summarize the metabolic features of immuno-cold and immuno-hot tumors. The cholesterol subgroup displays the worst prognosis in immuno-cold NSCLC with significant enrichment of the cholesterol gene signature, indicating targeting cholesterol synthesis is essential for the therapy for immuno-cold NSCLC. Statin, the inhibitor for cholesterol synthesis, can suppress the aggressiveness of NSCLC in vitro and in vivo and also drastically reverse immuno-cold to an inflamed phenotype in vivo which exhibited a higher response to ICB therapy. Moreover, both our in-house data and meta-analysis further support that statin can significantly enhance ICB efficacy. In terms of preliminary mechanisms, statin could transcriptionally inhibit PD-L1 expression and induce ferroptosis in NSCLC cells. Overall, we reveal the significance of cholesterol synthesis in NSCLC and demonstrate the improved therapeutic efficacy of ICB in combination with statin. These findings could provide a innovative clinical insight to treat NSCLC patients with immuno-cold tumors.
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Affiliation(s)
- Wenjun Mao
- Department of Cardiothoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Yun Cai
- Wuxi College of Clinical Medicine, Nanjing Medical University, Wuxi, China
| | - Danrong Chen
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guanyu Jiang
- Department of Cardiothoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Yongrui Xu
- Department of Cardiothoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Ruo Chen
- Department of Cardiothoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Fengxu Wang
- Department of Occupational Medicine and Environmental Toxicology, Nantong University, Nantong, China
| | - Xuehai Wang
- Department of Occupational Medicine and Environmental Toxicology, Nantong University, Nantong, China
| | - Mingfeng Zheng
- Department of Cardiothoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Xinyuan Zhao
- Department of Occupational Medicine and Environmental Toxicology, Nantong University, Nantong, China
| | - Jie Mei
- Department of Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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Li H, Sun Z, Li Y, Qi Q, Huang H, Wang X, Zhou J, Liu K, Yin P, Wang Z, Li X, Yang F. Disparate Genomic Characteristics of Patients with Early-Stage Lung Adenocarcinoma Manifesting as Radiological Subsolid or Solid Lesions. Lung Cancer 2022; 166:178-188. [DOI: 10.1016/j.lungcan.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/21/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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Park S, Lee SM, Choe J, Choi S, Kim S, Do KH, Seo JB. Differences in the prognostic implication of ground-glass opacity on CT according to pathological nodal status in lung cancers treated with lobectomy or pneumonectomy. Eur Radiol 2022; 32:4405-4413. [PMID: 35141781 DOI: 10.1007/s00330-022-08563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/08/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To clarify the prognostic significance of a ground-glass opacity (GGO) component according to T category and pathological nodal status in patients with resectable non-small cell lung cancer (NSCLC). METHODS Patients who underwent lobectomy or pneumonectomy for NSCLC between July 2010 and December 2017 were retrospectively included. Patients were divided into GGO and solid groups based on the presence of a GGO component on CT. The effects on survival of interactions between GGO and (a) pathological nodal status (pN) and (b) cT category were evaluated using Cox regression. RESULTS Out of 1545 patients, 548 were classified into the GGO group (pN0: 457, pN1/2: 91) and 997 into the solid group (pN0: 660, pN1/2: 337). There were interactions between the presence of GGO and pathological nodal status on 5-year disease-free survival (DFS; p = .006) and 5-year overall survival (OS; p = .02). In multivariate analysis, better survival of patients in the GGO group than in the solid group was observed only in pN0 category (adjusted hazard ratio [HR], 0.63 for 5-year DFS; p = .002 and 0.47 for 5-year OS; p = .002), but not in pN1/2 category. Moreover, in those with pN0 category, the favorable prognostic value of GGO was limited to those with cT1 category for 5-year DFS (adjusted HR, 0.48; p < .001) and those with cT1/2 category for 5-year OS (adjusted HR, 0.37; p = .002). CONCLUSIONS GGO was a favorable predictor of survival only in patients with pN0 category, showing an advantage in DFS for those with cT1 category and OS for those with cT1/2 category. KEY POINTS • The presence of ground-glass opacity was associated with a favorable prognosis, only in pathological node-negative patients (5-year disease-free survival, p = .002; 5-year overall survival, p = .002). • Within pathological node-negative patients, the effect of ground-glass opacity on 5-year disease-free survival was valid in patients with cT1 category (adjusted hazard ratio, 0.48; 95% confidence interval, 0.32-0.72; p < .001), but not in patients with cT2 or above category. • Within pathological node-negative patients, the effect of ground-glass opacity on 5-year overall survival was valid in patients with cT1/2 category (adjusted hazard ratio, 0.37; 95% confidence interval, 0.20-0.68; p = .002), but not in patients with cT3/4 category.
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Affiliation(s)
- Sohee Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
| | - Sehoon Choi
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehee Kim
- Department of Medical Statistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
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13
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Management of Ground-Glass Nodules: When and How to Operate? Cancers (Basel) 2022; 14:cancers14030715. [PMID: 35158981 PMCID: PMC8833330 DOI: 10.3390/cancers14030715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary An increasing number of lung cancer screening programs have detected the frequent occurrence of small pulmonary ground-glass nodules (GGNs). If GGN is an incidental finding, it should be followed according to the guidelines. A multidisciplinary team discussion should be initiated if a new solid component develops or the solid portion grows on follow-up CT. Preoperative attempts to biopsy solid components in part-solid GGNs are often not feasible and not helpful. If malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. Once the GGN is confirmed to be malignant, sub-lobar resection may be reasonable in the majority of cases, and the extent of lung resection should be determined based on the CT finding or intraoperative frozen section examination using special inflation technique. Although rare, the recurrence in the remaining lobe can occur especially in patients with high risk histologic features, which currently cannot accurately diagnosed either pre- or intra-operatively. Abstract With the increased popularity of low-dose computed tomography (LDCT), many patients present with pulmonary ground-glass nodules (GGNs), and the appropriate diagnostic and management strategy of those lesions make physicians be on the horn of the clinical dilemma. As there is not enough data available to set universally acceptable guidelines, the management of GGNs may be different. If GGN is an incidental finding through LDCT, the lesion should be followed according to the current guidelines. We recommend a multidisciplinary team discussion to be initiated if a new solid component develops or the solid portion size grows on follow-up CT as the risk of malignancy is high. Attempts to preoperatively biopsy solid components in part-solid GGNs are often not feasible and not helpful in clinical settings. Currently, if malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. If malignancy is confirmed, sub-lobar resection may provide an excellent oncologic outcome.
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Nakao M, Oikado K, Sato Y, Hashimoto K, Ichinose J, Matsuura Y, Okumura S, Ninomiya H, Mun M. Prognostic stratification according to size and dominance of radiologic solid component in clinical stage IA lung adenocarcinoma. JTO Clin Res Rep 2022; 3:100279. [PMID: 35199054 PMCID: PMC8844299 DOI: 10.1016/j.jtocrr.2022.100279] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Although several studies have investigated the prognostic significance of the radiographic appearance of stage IA lung adenocarcinoma, the prognostic impact of solid component size or consolidation-to-tumor ratio (CTR) of part-solid nodules (PSNs) still remains controversial. This study aimed to clarify the combined prognostic impact of the mentioned radiographic features of PSNs and compare it with that of pure solid nodules in the current TNM classification. Methods We retrospectively investigated 1014 patients with clinical stage IA (TNM eighth edition) adenocarcinoma who underwent curative resection. Overall survival (OS) and pathologic characteristics of pure solid nodules, solid-dominant PSNs (CTR > 0.5), and ground-glass opacity (GGO)-dominant PSNs (CTR ≤ 0.5) were compared according to T category. Results Patients with pure solid nodules (297 cases) had significantly shorter OS compared with those with PSNs (717 cases) (p < 0.001) but a marginal difference compared with those with solid-dominant PSNs (286 cases) (p = 0.051). No significant difference in OS was found according to T category in those with GGO-dominant PSNs (431 cases). Patients with cT1b and T1c solid-dominant PSNs had significantly worse prognosis compared with those with other PSNs and had comparable prognosis with those with cT1b pure solid nodules (p = 0.892). Higher frequency of nodal and lymphovascular involvement and pathologic upstaging was observed with T category progression in solid-dominant PSNs. Conclusions An hierarchy of prognosis and pathologic malignant characteristics was observed according to T category in patients with solid-dominant PSNs but not in those with GGO-dominant PSNs, suggesting the importance of classifying PSNs on the basis of solid component size and CTR for accurate prognostic comparison with pure solid nodules.
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Affiliation(s)
- Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
- Corresponding author. Address for correspondence: Masayuki Nakao, MD, PhD, Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Katsunori Oikado
- Department of Diagnostic Imaging Center, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinao Sato
- Department of Diagnostic Imaging Center, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kohei Hashimoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Ninomiya
- Department of Pathology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
- Division of Pathology, Cancer Institute, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
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15
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Chen H, Liu J, Lu L, Wang T, Xu X, Chu A, Peng W, Gong J, Tang W, Gu Y. Volumetric segmentation of ground glass nodule based on 3D attentional cascaded residual U-net and conditional radom field. Med Phys 2021; 49:1097-1107. [PMID: 34951492 DOI: 10.1002/mp.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ground glass nodule (GGN) segmentation is one of the important and challenging tasks in diagnosing early-stage lung adenocarcinomas. Manually delineation of 3D GGN in computed tomography (CT) image is a subjective, laborious and tedious task, which presents poor repeatability. PURPOSE To reduce the annotation burden and improve the segmentation performance, this study proposes a 3D deep learning-based volumetric segmentation model to segment the GGN in CT images. METHODS A total of 379 GGNs were retrospectively collected from the public database, Shanghai Pulmonary Hospital (SHPH) and Fudan University Shanghai Cancer Center (FUSCC). First, a series of image pre-processing techniques involving image resampling, intensity normalization, 3D nodule patch cropping, and data augmentation, were adopted to generate the input images for the deep learning model by using the CT scans. Then, a 3D attentional cascaded residual network (ACRU-Net) was proposed to develop the deep learning-based segmentation model by using residual network and atrous spatial pyramid pooling module. To improve the model performance, a voxel-based conditional random field (CRF) method was used to optimize the segmentation results. Finally, a balanced cross-entropy and Dice combined loss function was applied to train and build the segmentation model. RESULTS Testing on SHPH and FUSCC datasets, the proposed method generates the Dice coefficients of 0.721±0.167 and 0.733±0.100, respectively, which are higher than that of 3D residual U-Net and ACRU-Net without CRF optimization. CONCLUSIONS The results demonstrated that combining 3D ACRU-Net and CRF effectively improved the GGN segmentation performance. The proposed segmentation model may provide a potential tool to help the radiologist in the segmentation and diagnosis of 3D GGN. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hui Chen
- Department of Radiology, Medical Community of Linhai First People's Hospital, Linhai, Zhejiang, 317000, China
| | - Jiyu Liu
- Department of Radiology, Shanghai Pulmonary Hospital, Shanghai, 200433, China
| | - Liangjian Lu
- Department of Radiology, Medical Community of Linhai First People's Hospital, Linhai, Zhejiang, 317000, China
| | - Ting Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaomin Xu
- Department of Radiology, Medical Community of Linhai First People's Hospital, Linhai, Zhejiang, 317000, China
| | - Aina Chu
- Department of Radiology, Medical Community of Linhai First People's Hospital, Linhai, Zhejiang, 317000, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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16
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Identification of predictors for brain metastasis in newly diagnosed non-small cell lung cancer: a single-center cohort study. Eur Radiol 2021; 32:990-1001. [PMID: 34378076 DOI: 10.1007/s00330-021-08215-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/22/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To identify clinical and staging chest CT characteristics predictive of brain metastasis in patients with newly diagnosed NSCLC dichotomized according to resectability. METHODS Patients newly diagnosed with NSCLC of clinical stages II-IV between November 2017 and October 2018 were enrolled and classified into resectable (stage II+IIIA) and unresectable stages (stage IIIB/C+IV) according to chest CT. Associations of clinicopathological characteristics and CT findings with brain metastasis were analyzed using logistic regression. Predictive models were evaluated using receiver operating characteristics curve analysis. A subgroup analysis for unresectable-stage patients with known epidermal growth factor receptor gene (EGFR) mutation status was performed. RESULTS This study included 911 NSCLC patients (mean age, 65 ± 11 years; 620 men), 194 of whom were diagnosed with brain metastasis. For resectable stages, independent predictors for brain metastasis were N2-stage (13 of 25 patients), absence of air-bronchogram/bubble lucency (23 of 25 patients), and presence of spiculation (15 of 25 patients), with a model combining the two imaging features showing an AUC of 0.723. In unresectable stages, independent predictors of brain metastasis were younger age, female sex, extrathoracic metastasis, and adenocarcinoma, with models combining these showing AUCs of 0.675-0.766. In the subgroup with known EGFR-mutation status, extrathoracic metastasis and positive EGFR mutation were independent predictors of brain metastasis, with the model showing AUCs of 0.641-0.732. CONCLUSION CT-derived imaging features, clinical stages, lung cancer subtype, and EGFR mutation were associated with brain metastasis in patients with newly diagnosed NSCLC. The predictors were completely different between resectable and unresectable stages. KEY POINTS • In resectable stages of NSCLC, two imaging features (absence of air-bronchogram/bubble lucency and presence of spiculation) and N2 stage were independent predictors of brain metastasis. • In unresectable stages of NSCLC, younger age, female sex, extrathoracic metastasis, and adenocarcinoma were associated with brain metastasis. • In the subgroup of NSCLC with known EGFR-mutation status, extrathoracic metastasis and positive EGFR mutation were independent predictors of brain metastasis.
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Hammer MM, Eckel AL, Palazzo LL, Kong CY. Cost-Effectiveness of Treatment Thresholds for Subsolid Pulmonary Nodules in CT Lung Cancer Screening. Radiology 2021; 300:586-593. [PMID: 34128723 DOI: 10.1148/radiol.2021204418] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Guidelines such as the Lung CT Screening Reporting and Data System (Lung-RADS) are available for determining when subsolid nodules should be treated within lung cancer screening programs, but they are based on expert opinion. Purpose To evaluate the cost-effectiveness of varying treatment thresholds for subsolid nodules within a lung cancer screening setting by using a simulation model. Materials and Methods A previously developed model simulated 10 million current and former smokers undergoing CT lung cancer screening who were assumed to have a ground-glass nodule (GGN) at baseline. Nodules were allowed to grow and to develop solid components over time according to a monthly cycle and lifetime horizon. Management strategies generated by varying treatment thresholds, including the solid component size and use of the Brock risk calculator, were tested. For each strategy, average U.S. costs and quality-adjusted life years (QALYs) gained per patient were computed, and the incremental cost-effectiveness ratios (ICERs) of those on the efficient frontier were calculated. One-way and probabilistic sensitivity analyses of results were performed by varying several relevant parameters, such as treatment costs or malignancy growth rates. Results Variants of the Lung-RADS guidelines that did not treat pure GGNs were cost-effective. Strategies based on the Brock risk calculator did not reach the efficient frontier. The strategy with the highest QALYs under a willingness-to-pay threshold of $100 000 per QALY included no treatment of GGNs and a threshold of 4-mm solid component size for treatment of subsolid nodules. This strategy yielded an ICER of $52 993 per QALY (95% CI: 44 407, 64 372). Probabilistic sensitivity analysis showed this was the optimal strategy under a range of parameter variations. Conclusion Treatment of pure ground-glass nodules was not cost-effective. Strategies that use modifications of the Lung CT Screening Reporting and Data System guidelines were cost-effective for treating part-solid nodules; an optimal threshold of 4 mm for the solid component yielded the most quality-adjusted life years. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Mark M Hammer
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
| | - Andrew L Eckel
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
| | - Lauren L Palazzo
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
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18
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Lai J, Li Q, Fu F, Zhang Y, Li Y, Liu Q, Chen H. Subsolid Lung Adenocarcinomas: Radiological, Clinical and Pathological Features and Outcomes. Semin Thorac Cardiovasc Surg 2021; 34:702-710. [PMID: 34087379 DOI: 10.1053/j.semtcvs.2021.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
Lung adenocarcinomas manifesting as subsolid nodules usually have a favorable prognosis. This study aimed to have a comprehensive investigation of the radiological and clinicopathologic features and oncological outcomes of subsolid nodules. Between March 2010 and December 2015, 865 patients with surgically resected clinical IA subsolid lung adenocarcinoma were retrospectively reviewed. Patients were classified into the pure ground-glass nodules (GGN) (pGGN [n = 358], without solid component on lung and mediastinal windows), heterogeneous GGN (hGGN [n = 65], only with solid components on lung window), and real part-solid nodule (rPSN [n = 442], with solid component on both lung and mediastinal windows) groups. The clinicopathological features and survival time of the three groups were compared between groups. There was a significant increase in median tumor size (P < 0.001), solid component size measured at lung window (LW-SCS) (P < 0.001), and the proportion of invasive adenocarcinoma subtypes (P < 0.001) from pGGNs to hGGNs to rPSNs. After adjustment for LW-SCS, adenocarcinomas with predominant lepidic patterns were still more common in hGGNs than in rPSNs (P = 0.009). Patients with rPSNs had a significantly worse recurrence-free survival (RFS) than those with pGGNs and hGGNs (5-year: 91.9% versus 100% versus 100%, P < 0.001). Multivariate Cox analyses revealed that gender (both P < 0.05) and clinical T category (based on lung window [LW-cT] [P = 0.002] or mediastinal window [MW-cT] [P < 0.001]) were independent prognostic factors of RFS in the rPSN group. HGGNs represented as an intermediate subtype between pGGNs and rPSNs. Both pGGNs and hGGNs had excellent outcomes, while rPSNs exhibited a worse prognosis than them. Clinical T category and gender had prognostic implications for rPSNs.
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Affiliation(s)
- Jinglei Lai
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiao Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Quan Liu
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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19
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Nakada T, Kuroda H. Narrative review of optimal prognostic radiological tools using computed tomography for T1N0-staged non-small cell lung cancer. J Thorac Dis 2021; 13:3171-3181. [PMID: 34164207 PMCID: PMC8182523 DOI: 10.21037/jtd-20-3380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Various radiological tools can predict the prognosis of non-small cell lung cancer (NSCLC). In this study, we evaluated the prognostic effect of different radiological tools such as whole tumor size (WTS), consolidation size (CS), consolidation tumor ratio (CTR), tumor disappearance ratio (TDR), mediastinal diameter (MD), and ground glass opacity (GGO) using high-resolution computed tomography (HRCT). We reviewed recent retrospective studies on the predictive effect of these radiological tools on disease-free survival (DFS) and overall survival (OS) in patients with T1N0-staged NSCLC. We searched PubMed and the British Library databases for the English literature published from January 2010 to December 2020 and generated a total of 32 publications (NSCLC, n=16; adenocarcinoma, n=16). The TNM classification version 7 was used in 18 studies, and version 8 in 14 studies. The evaluated radiological parameters were WTS, CS including T category, CTR, TDR, MD, presence of GGO, GGO ratio, and pure GGO. This review suggested that CS, MD, and the presence of GGO are optimal prognostic radiological tools for cT1N0-Staged NSCLC. CTR or TDR for part solid nodules (PSNs) is not a well-accepted prognostic factor. Further investigations are required to differentiate between benign scars and malignant components on HRCT and evaluate the prognosis of PSNs (1< CS ≤2 cm) with large WTS in the future.
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Affiliation(s)
- Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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20
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Yin J, Xi J, Liang J, Zhan C, Jiang W, Lin Z, Xu S, Wang Q. Solid Components in the Mediastinal Window of Computed Tomography Define a Distinct Subtype of Subsolid Nodules in Clinical Stage I Lung Cancers. Clin Lung Cancer 2021; 22:324-331. [PMID: 33789831 DOI: 10.1016/j.cllc.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to validate the clinicopathologic characteristics and prognostic value of the presence of solid components in the mediastinal window of computed tomography scan in clinical stage I pulmonary subsolid nodules (SSNs). METHODS We retrospectively evaluated patients with pulmonary SSNs resected between 2011 and 2016. We classified SSNs into heterogeneous ground-glass nodules (HGGNs) (solid component detected only in lung window) and part-solid nodules (PSNs) (solid component detected both in lung/mediastinal windows). RESULTS A total of 487 patients (216 PSNs) were included. PSNs were associated with higher frequencies of micropapillary or solid pathologic patterns (18.1% vs. 3.3%; P < .001), epidermal growth factor receptor gene mutation (39.4% vs. 32.8%), and other types of gene mutations (2.3% vs. 1.1%; P = .043). Logistic regression analysis revealed that male sex (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.20-5.57; P = .016) and higher consolidation tumor ratio (CTR) (OR, 110.04; 95% CI, 8.56-1414.39; P < .001) remained independent for invasive adenocarcinomas with poor differentiation. Receiver operating characteristic analyses revealed that solid component size in the mediastinal window (area under the curve [AUC], 0.731; 95% CI, 0.653-0.808; P < .0001) showed a better predictive ability to poor differentiation compared with solid component size in the lung window and CTR. The 5-year recurrence-free survival (RFS) rate of PSNs was worse than that of HGGNs (94.6% vs. 99.1%; P = .019). Multivariate Cox regression revealed that positive lymph node status (hazard ratio, 22.99; 95% CI, 4.52-116.86; P < .001) indicated worse RFS for PSNs. CONCLUSION SSNs with solid components in mediastinal window demonstrated clinicopathologic and prognostic features different from those without in clinical stage I lung cancer. Solid components in mediastinal window was a strong predictor of poor differentiation.
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Affiliation(s)
- Jiacheng Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Songtao Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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21
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Li M, Xu Z, Zhan C, Wang Q. A Few Clouds Over the Eighth Edition T Categorization System. J Thorac Oncol 2021; 15:e159-e160. [PMID: 32981601 DOI: 10.1016/j.jtho.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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22
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Fu F, Zhou Y, Zhang Y, Chen H. Lung cancer screening strategy for non-high-risk individuals: a narrative review. Transl Lung Cancer Res 2021; 10:452-461. [PMID: 33569326 PMCID: PMC7867778 DOI: 10.21037/tlcr-20-943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the deadliest malignancy worldwide, accounting for almost 20% of all cancer deaths. Clinical trials, such as NLST and NELSON, have proved the survival benefit of lung cancer screening using low-dose computed tomography (LDCT), and most of the lung cancer screening guidelines recommended annual lung cancer screening by LDCT for high-risk individuals. However, a relatively high proportion of lung cancer patients do not have risk factors, and it is questionable whether non-high-risk individuals should receive LDCT screening. In this review, we reviewed risk factors of lung cancer and summarized the benefits and potential harms of LDCT screening. After clarifying the differences between China and western countries in lung cancer screening, we recommended that non-high-risk individuals should receive LDCT screening with an interval of five to ten years. To better balance benefits and harms from LDCT screening, we also proposed a flexible screening strategy using LDCT based on lung cancer risk. Hopefully, it may help reduce unnecessary radiation exposure from CT scans while decreasing mortality of lung cancer.
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Affiliation(s)
- Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaodong Zhou
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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23
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Zhu E, Dai C, Xie H, Su H, Hu X, Li M, Fan J, Liu J, Zhu Q, Zhang L, Ke H, Chen C. Lepidic component identifies a subgroup of lung adenocarcinoma with a distinctive prognosis: a multicenter propensity-matched analysis. Ther Adv Med Oncol 2020; 12:1758835920982845. [PMID: 33488781 PMCID: PMC7768877 DOI: 10.1177/1758835920982845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/01/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Our aim was to investigate the prognostic impact of the lepidic component on T stage in patients with lung adenocarcinoma (LUAD). Methods: A retrospective data set including 863 cases of LUAD with lepidic component and 856 cases without lepidic component was used to identify matched lepidic-positive and lepidic-negative cohorts (n = 376 patients per group) using a propensity-score matching. Primary outcome variables included recurrence-free survival (RFS) and overall survival (OS). Prognostic factors were assessed by Cox regression analysis and Kaplan–Meier estimates. Results: Multivariate analysis revealed that lepidic component presence was an independent prognostic factor for prolonged RFS (p < 0.001) and OS (p < 0.001). Furthermore, lepidic ratio (LR) >25% or ⩽25% were confirmed to be independent prolonged survival predictors. No survival differences were observed between patients with LUAD with LR >25% or ⩽25% (RFS p = 0.333; OS p = 0.078). The 5-year OS rates of patients with LUAD with a lepidic component were 90% regardless of the T stage, and these survival rates were significantly better than those of patients with LUAD without a lepidic component in the corresponding T stage. Multivariate analysis confirmed that T stage was associated with survival only in patients with LUAD without a lepidic component. Conclusions: Lepidic component presence identifies a LUAD subgroup with an excellent prognosis independent of the LR, pathological T classification. Considering the lepidic component presence may improve prognostic predictions for patients with LUAD.
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Affiliation(s)
- Erjia Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ming Li
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Junqiang Fan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jinshi Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province Hospital, Nanjing, People's Republic of China
| | - Lei Zhang
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Honggang Ke
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Road 507, Shanghai 200443, China
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24
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Zhang Y, Fu F, Chen H. Management of Ground-Glass Opacities in the Lung Cancer Spectrum. Ann Thorac Surg 2020; 110:1796-1804. [PMID: 32525031 DOI: 10.1016/j.athoracsur.2020.04.094] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of lung ground-glass opacity (GGO) lesions are detected. This review focuses on lung adenocarcinoma manifesting as GGO. METHODS We performed a literature search of the PubMed/MEDLINE database to identify articles reporting GGO. The following terms were used: GGO, ground-glass opacity, GGN, ground-glass nodule, part-solid nodule, and subsolid nodule. RESULTS GGO is a nonspecific radiologic finding showing a hazy opacity without blocking underlying pulmonary vessels or bronchial structures. The pathology of GGO can be benign, preinvasive, or invasive adenocarcinoma. Although radiographic features may indicate malignancy, a short period of follow-up is the optimal method to distinguish between benign and malignant GGO lesions. Pathologically, not only lepidic, but also nonlepidic growth patterns can present as GGO. Lung adenocarcinoma with a GGO component is associated with excellent survival compared with solid lesions. Moreover, there are distinct prognostic factors in patients with lung adenocarcinoma manifesting as GGO or solid lesions. For selected GGO-featured lung adenocarcinoma, sublobar resection with selective or no mediastinal lymph node dissection may be sufficient. Intraoperative frozen section is an effective method to guide resection strategy. A less intensive postoperative surveillance strategy may be more appropriate given the excellent survival. Management of multiple GGO lesions requires comprehensive considerations of GGO characteristics and patient conditions. CONCLUSIONS Lung adenocarcinoma manifesting as GGO defines a special clinical subtype with excellent prognosis. The management of GGO-featured lung adenocarcinoma should be distinct from that of solid lesions.
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Affiliation(s)
- Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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