title: Preoperative CT Predicting Recurrence of Surgically Resected Adenocarcinoma of the Lung.
abstract: Pathologic lymphovascular invasion (LVI) has been shown to be related to tumor recurrence in lung adenocarcinoma (ADC). We investigated preoperative computed tomography (CT) findings that may be related to pathologic LVI and recurrence of surgically managed stage I-II ADC of the lung.Consecutive patients (n = 275) with ADC from January 2013 to December 2013 were retrospectively enrolled. Two independent chest radiologists analyzed the CT findings. Clinical, CT (stage, margin, pleural tag, axial location, and peritumoral interstitial thickening), and pathologic findings (stage, % lepidic growth, and LVI) were reviewed. Cox proportional hazard regression analysis was used to estimate the hazard ratios (HRs) for patients with (n = 34) and without (n = 241) recurrence.The κ index for agreement on the CT findings between radiologists was 0.705 to 0.845. In univariate analysis, % lepidic growth (P = 0.006), LVI (P < 0.001), size (P < 0.001), and staging (P = 0.011) differentiated significantly between patients with and without recurrence. Long diameter (P < 0.001), mass type (P < 0.001), marginal lobulation (P = 0.020), central location (P < 0.001), and peritumoral interstitial thickening (P < 0.001) were significantly related to recurrence on CT. Peritumoral interstitial thickening was positively correlated with tumor size (P < 0.001), LVI (P < 0.001), N staging (P = 0.005), stage (P < 0.001), mass type (P < 0.001), and recurrence (P = 0.003). In multivariate analysis, size (HR, 1.052; 95% CI, 1.022-1.082; P < 0.001), central location (HR, 3.152; 1.387-7.166; P = 0.006), and LVI (HR, 2.153, 95% CI, 1.038-4.465; P = 0.039) were independent predictors of recurrence.Large, centrally located tumors with LVI tend to recur after surgery. Presence of peritumoral interstitial thickening on CT appears to predict pathologic LVI and recurrence.
authors.affiliation: From the the Department of Radiology and Research Institute of Radiology (HJK, HX, MYK), Department of Oncology (C-MC), Pulmonary and Critical Care Medicine (C-MC), Department of Pathology (JSS), Thoracic and Cardiovascular Surgery (HRK), and Clinical Epidemiology and Biostatistics (JBL), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China (HX).
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Koo
authors.forename: Hai
authors.initials: H
authors.lastname: Xu
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Choi
authors.forename: Joon Seon
authors.initials: JS
authors.lastname: Song
authors.forename: Hyeong Ryul
authors.initials: HR
authors.lastname: Kim
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
authors.forename: Mi Young
authors.initials: MY
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed