Prognostic importance of volumetric measurements in stage I lung adenocarcinoma.
OBJECTIVE
To perform volumetric analysis of stage I lung adenocarcinomas by using an automated computer program and to determine value of volumetric computed tomographic (CT) measurements associated with prognostic factors and outcome.


METHODS
Consecutive patients (n = 145) with stage I lung adenocarcinoma who underwent surgery after preoperative chest CT were enrolled. By using volumetric automated computer-assisted analytic program, nodules were classified into three subgroups: pure ground glass, part solid, or solid. Total tumor volume, solid tumor volume, and percentage of solid volume of each cancer were calculated after eliminating vessel components. One radiologist measured the longest diameter of the solid tumor component and of total tumor with their ratio, which was defined as solid proportion. The value of these quantitative data by examining associations with pathologic prognostic factors and outcome measures (disease-free survival and overall survival) were analyzed with logistic regression and Cox proportional hazards regression models, respectively. Significant parameters identified at univariate analysis were included in the multiple analyses.


RESULTS
All 22 recurrences occurred in patients with nodules classified as part solid or solid. Multiple logistic regression analysis revealed that percentage of solid volume of 63% or greater was an independent indicator associated with pleural invasion (P = .01). Multiple Cox proportional hazards regression analysis revealed that percentage of solid volume of 63% or greater was a significant indicator of lower disease-free survival (hazard ratio, 18.45 [95% confidence interval: 4.34, 78.49]; P < .001). Both solid tumor volume of 1.5 cm(3) or greater and percentage of solid volume of 63% or greater were significant indicators of decreased overall survival (hazard ratio, 5.92 and 9.60, respectively [95% confidence interval: 1.17, 30.33 and 1.17, 78.91, respectively]; P = .034 and .036, respectively).


CONCLUSIONS
Two volumetric measurements (solid volume, ≥1.5 cm(3); percentage of solid volume, ≥63%) were found to be independent indicators associated with increased likelihood of recurrence and/or death in patients with stage I adenocarcinoma.
From the Department of Diagnostic Radiology, Stanford University School of Medicine, 1201 Welch Rd, Stanford, CA 94305 (M.Y., A.N.L.); Departments of Radiology (M.Y., T.G., K.U., O.H., H.S., N.T.), Pathology (E.M.), and Respiratory Surgery (S.W.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Radiology, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan (E.M.); Department of Radiology (M.K., H.W.) and Division of Thoracic Surgery (M.I., M.O.), National Cancer Center, Tokyo, Japan; and Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan (T.J.).
Masahiro
M
Yanagawa
Yuko
Y
Tanaka
Ann N
AN
Leung
Eiichi
E
Morii
Masahiko
M
Kusumoto
Shunichi
S
Watanabe
Hirokazu
H
Watanabe
Masayoshi
M
Inoue
Meinoshin
M
Okumura
Tomoko
T
Gyobu
Ken
K
Ueda
Osamu
O
Honda
Hiromitsu
H
Sumikawa
Takeshi
T
Johkoh
Noriyuki
N
Tomiyama
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D012984:Software; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18