Kuroda Hiroaki, Mori Shnsuke, Tanaka Hirotaka, Yoshida Tatsuya, Mizuno Tetsuya, Sakakura Noriaki, Yatabe Yasushi, Iwata Hiroshi, Sakao Yukinori
Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Aichi, Japan.
Oncotarget. 2017 Dec 18;9(12):10745-10753. doi: 10.18632/oncotarget.23395. eCollection 2018 Feb 13.
We previously proposed measuring tumor size using mediastinal window setting on high-resolution computed tomography (CT) as a simple and useful modality for preoperative prognostication of small adenocarcinoma. Hence, the importance of tumor volume and positron emission tomography (PET) for preoperative prognostication of clinical stage IA (cIA) adenocarcinoma was studied.
We retrospectively evaluated total 324 patients who underwent pulmonary resection of cIA adenocarcinoma between July 2008 and August 2015. Reconstructed three-dimensional (3D) images from 1-1.5 mm-sliced CT were evaluated for whole tumor volume including ground grass opacity, consolidation volume on lung window setting, and mediastinal window volume (MWV). The values examined by PET were total lesion glycolysis (TLG), and maximum standardized uptake (SUV max) and mean. Pathologic status was evaluated according to tumor maximum size, invasive size (IS), lymphatic and vascular vessels, pleural invasion (ly/v/pl), and TNM staging.
According to ly/v/pl invasion and lymph node positivity, no variables were superior to IS. We used Mean/MWV (SUV mean x MWV) to evaluate tumor quality and quantity in the role of surrogate TLG. Mean/MWV were superior to IS. Additionally, Mean/MV was associated with lymph node metastases. Among the various histologic subtypes, solid-predominant had the highest expression of Mean/MV. The higher Mean/MV significantly contributed to unfavorable disease-free survival in cIA adenocarcinomas, but not to overall survival.
The mean/MWV value determination on 3D-reconstructed CT images was a simple and useful preoperative modality for predicting invasive facet in cIA adenocarcinoma. However, higher values didn't significantly affect overall survival.
我们之前提出，在高分辨率计算机断层扫描（CT）上使用纵隔窗设置测量肿瘤大小，作为小腺癌术前预后评估的一种简单且有用的方法。因此，本研究探讨了肿瘤体积和正电子发射断层扫描（PET）在临床IA期（cIA）腺癌术前预后评估中的重要性。
我们回顾性评估了2008年7月至2015年8月期间接受cIA腺癌肺切除术的324例患者。对1-1.5毫米层厚CT重建的三维（3D）图像进行评估，以测量整个肿瘤体积，包括磨玻璃影、肺窗设置下的实变体积和纵隔窗体积（MWV）。PET检查的数值包括总病变糖酵解（TLG）、最大标准化摄取值（SUV max）及平均值。根据肿瘤最大尺寸、浸润尺寸（IS）、淋巴管和血管、胸膜侵犯（ly/v/pl）以及TNM分期评估病理状态。
根据ly/v/pl侵犯和淋巴结阳性情况，没有变量优于IS。我们使用平均/纵隔窗体积（SUV平均值×MWV）来评估肿瘤的质量和数量，以替代TLG。平均/纵隔窗体积优于IS。此外，平均/纵隔窗体积与淋巴结转移相关。在各种组织学亚型中，实性为主型的平均/纵隔窗体积表达最高。较高的平均/纵隔窗体积显著影响cIA腺癌的无病生存率，但对总生存率无显著影响。
在3D重建CT图像上测定平均/纵隔窗体积值，是预测cIA腺癌浸润情况的一种简单且有用的术前方法。然而，较高的值对总生存率没有显著影响。
