title: A combination of preoperative CT findings and postoperative serum CEA levels improves recurrence prediction for stage I lung adenocarcinoma.
abstract: OBJECTIVE
  To assess the prognostic value of combined evaluation of preoperative CT findings and pre/postoperative serum carcinoembryonic antigen (CEA) levels for pathological stage I lung adenocarcinoma.
  
  
  METHODS
  This retrospective study included 250 consecutive patients who underwent complete resection for ≤ 3-cm pathological stage I (T1-2aN0M0) adenocarcinomas (132 men, 118 women; mean age, 67.8 years). Radiologists evaluated following CT findings: maximum tumor diameter, percentage of solid component (%solid), air bronchogram, spiculation, adjacency of bullae or interstitial pneumonia (IP) around the tumor, notch, and pleural indent. These CT findings, pre/postoperative CEA levels, age, gender, and Brinkman index were assessed by Cox proportional hazards model to determine the best prognostic model. Prognostic accuracy was examined using the area under the receiver operating characteristic curve (AUC).
  
  
  RESULTS
  Median follow-up period was 73.2 months. In multivariate analysis, high %solid, adjacency of bullae or IP around the tumor, and high postoperative CEA levels comprised the best combination for predicting recurrence (P<0.05). A combination of these three findings had a greater accuracy in predicting 5-year disease-free survival than did %solid alone (AUC=0.853 versus 0.792; P=0.023), with a sensitivity of 85.7% and a specificity of 74.3% at the optimal threshold. The best cut-off values of %solid and postoperative CEA levels for predicting high-risk patients were ≥ 48% and ≥ 3.7 ng/mL, respectively.
  
  
  CONCLUSIONS
  Compared to %solid alone, combined evaluation of %solid, adjacency of bullae or IP change around the tumor, and postoperative CEA levels improves recurrence prediction for stage I lung adenocarcinoma.
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan. Electronic address: xackey2001@gmail.com.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Yamazaki
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Division of Cellular and Molecular Pathology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kunii
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tasaki
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ikeda
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsuchida
authors.affiliation: Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Aoyama
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D057234:Preoperative Period; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D002272:Carcinoembryonic Antigen
keywords: Chest CT imaging; Lung adenocarcinoma; Lung cancer; Prognosis; Serum CEA levels