title: Pleural retraction and intra-tumoral air-bronchogram as prognostic factors for stage I pulmonary adenocarcinoma following complete resection.
abstract: OBJECTIVE
  We have retrospectively analyzed the postoperative prognostic factors for 116 patients with stage I adenocarcinoma, with special reference to pleural retraction and intra-tumoral air-bronchogram imaged by computed tomography, which may represent the biological features of pulmonary adenocarcinoma for the retraction of surrounding tissues due to central necrosis and air space-lining growth, respectively.
  
  
  METHODS
  The subgroups divided according to the presence of pleural retraction and/or intra-tumoral air-bronchogram on pre-operative CT were compared with respect to the postoperative disease-free survival (DFS) and other clinico-pathological factors.
  
  
  RESULTS
  The rates of DFS at 5 years associated with 61 patients with pleural retraction and with 55 patients without pleural retraction were 64.4% and 91.3%, respectively (P = 0.0052), and those associated with 83 patients with air-bronchogram-positive tumors and with 33 patients with air-bronchogram-negative tumors were 81.8% and 64.8%, respectively (P = 0.0040). The DFS at 5 years associated with T1 (73 patients) and T2 (43 patients) were 83.6% and 64.3%, respectively (P = 0.0153). The Cox proportional hazards model analysis revealed that the presence of pleural retraction and the absence of air-bronchogram were independent factors for poor prognosis with relative risks of 7.8 and 5.1, respectively. Pathological T factor was also a significant prognostic factor with a relative risk of 3.2. Seventeen patients with pleural retraction-positive and air-bronchogram-negative tumors showed the high recurrence rate of 47.5% and a poor prognosis with DFS at 5 years of 35.1%.
  
  
  CONCLUSIONS
  These results suggested that, in stage I adenocarcinoma, the degree of malignant potential may be well figured by radiological imaging, with a significant affect on susceptibility of recurrence following complete resection.
authors.affiliation: Department of Surgery II, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Yoshino
authors.forename: R
authors.initials: R
authors.lastname: Nakanishi
authors.forename: M
authors.initials: M
authors.lastname: Kodate
authors.forename: T
authors.initials: T
authors.lastname: Osaki
authors.forename: T
authors.initials: T
authors.lastname: Hanagiri
authors.forename: M
authors.initials: M
authors.lastname: Takenoyama
authors.forename: T
authors.initials: T
authors.lastname: Yamashita
authors.forename: H
authors.initials: H
authors.lastname: Imoto
authors.forename: S
authors.initials: S
authors.lastname: Taga
authors.forename: K
authors.initials: K
authors.lastname: Yasumoto
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001995:Bronchography / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008175:Lung Neoplasms / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology*; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome