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Zheng X, Li R, Fan L, Ge Y, Li W, Feng F. Prognostic predictors of radical resection of stage I-IIIB non-small cell lung cancer: the role of preoperative CT texture features, conventional imaging features, and clinical features in a retrospectively analyzed. BMC Pulm Med 2023; 23:122. [PMID: 37060067 PMCID: PMC10105471 DOI: 10.1186/s12890-023-02422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND To investigate the value of preoperative computed tomography (CT) texture features, routine imaging features, and clinical features in the prognosis of non-small cell lung cancer (NSCLC) after radical resection. METHODS Demographic parameters and clinically features were analyzed in 107 patients with stage I-IIIB NSCLC, while 73 of these patients received CT scanning and radiomic characteristics for prognosis assessment. Texture analysis features include histogram, gray size area matrix and gray co-occurrence matrix features. The clinical risk features were identified using univariate and multivariate logistic analyses. By incorporating the radiomics score (Rad-score) and clinical risk features with multivariate cox regression, a combined nomogram was built. The nomogram performance was assessed by its calibration, clinical usefulness and Harrell's concordance index (C-index). The 5-year OS between the dichotomized subgroups was compared using Kaplan-Meier (KM) analysis and the log-rank test. RESULTS Consisting of 4 selected features, the radiomics signature showed a favorable discriminative performance for prognosis, with an AUC of 0.91 (95% CI: 0.84 ~ 0.97). The nomogram, consisting of the radiomics signature, N stage, and tumor size, showed good calibration. The nomogram also exhibited prognostic ability with a C-index of 0.91 (95% CI, 0.86-0.95) for OS. The decision curve analysis indicated that the nomogram was clinically useful. According to the KM survival curves, the low-risk group had higher 5-year survival rate compared to high-risk. CONCLUSION The as developed nomogram, combining with preoperative radiomics evidence, N stage, and tumor size, has potential to preoperatively predict the prognosis of NSCLC with a high accuracy and could assist to treatment for the NSCLC patients in the clinic.
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Affiliation(s)
- Xingxing Zheng
- Department of Radiology, Xi'an Jiaotong University, Xi'an, 710049, China
- Department of Radiology, Baoji Central Hospital, Baoji, 721000, China
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, No. 30 Tongyangbei Road, Tongzhou District, Nantong, 226361, China
| | - Rui Li
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, No. 30 Tongyangbei Road, Tongzhou District, Nantong, 226361, China
| | - Lihua Fan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, 712000, China
| | - Yaqiong Ge
- GE Healthcare China, Shanghai, 210000, China
| | - Wei Li
- Department of Radiology, Baoji Central Hospital, Baoji, 721000, China
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, No. 30 Tongyangbei Road, Tongzhou District, Nantong, 226361, China.
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Kuijvenhoven JC, Livi V, Szlubowski A, Ninaber M, Stöger JL, Widya RL, Bonta PI, Crombag LC, Braun J, van Boven WJ, Trisolini R, Korevaar DA, Annema JT. Endobronchial ultrasound for T4 staging in patients with resectable NSCLC. Lung Cancer 2021; 158:18-24. [PMID: 34098221 DOI: 10.1016/j.lungcan.2021.05.032] [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: 02/28/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In lung cancer patients, accurate assessment of mediastinal and vascular tumor invasion (stage T4) is crucial for optimal treatment allocation and to prevent unnecessary thoracotomies. We assessed the diagnostic accuracy of linear endobronchial ultrasound (EBUS) for T4-status in patients with centrally located lung cancer. METHODS This is a retrospective study among consecutive patients who underwent EBUS for diagnosis and staging of lung cancer in four hospitals in The Netherlands (Amsterdam, Leiden), Italy (Bologna) and Poland (Zakopane) between 04-2012 and 04-2019. Patients were included if the primary tumor was detected by EBUS and subsequent surgical-pathological staging was performed, which served as the reference standard. T4-status was extracted from EBUS and pathology reports. Chest CT's were re-reviewed for T4-status. RESULTS 104 patients with lung cancer in whom EBUS detected the primary tumour, and who underwent subsequent surgical-pathological staging were included. 36 patients (35 %) had T4-status, based on vascular (n = 17), mediastinal (n = 15), both vascular and mediastinal (n = 3), or oesophageal invasion (n = 1). For EBUS, sensitivity, specificity, PPV and NPV for T4-status were (n = 104): 63.9 % (95 %CI 46.2-79.2 %), 92.6 % (83.7-97.6 %), 82.1 % (65.6-91.7 %), and 82.9 % (75.7-88.2 %), respectively. For chest CT (n = 72): 61.5 % (95 %CI 40.6-79.8 %), 37.0 % (23.2-52.5 %), 35.6 % (27.5-44.6 %), and 63.0 % (47.9-75.9 %), respectively. When combining CT and EBUS with concordant T4 status (n = 33): 90.9 % (95 %CI 58.7-99.8 %), 77.3 % (54.6-92.20 %), 66.7 % (47.5-81.6 %), and 94.4 % (721-99.1%), respectively. CONCLUSION Both EBUS and CT alone are inaccurate for assessing T4-status as standalone test. However, combining a negative EBUS with a negative CT may rule out T4-status with high certainty.
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Affiliation(s)
- Jolanda C Kuijvenhoven
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Vanina Livi
- Interventional Pulmonology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Artur Szlubowski
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Maarten Ninaber
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Lauran Stöger
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ralph L Widya
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Laurence C Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jerry Braun
- Department of Cardio-thoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Willem Jan van Boven
- Department of Cardio-thoracic Surgery, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands.
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