Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
J Thorac Oncol. 2018 Dec;13(12):1864-1872. doi: 10.1016/j.jtho.2018.09.023. Epub 2018 Oct 4.
Our study aimed to analyze the prognostic implication of the multiplicity of solid portions in part-solid nodules (PSNs) on computed tomography scans and compare the prognostic performance of various measures of solid portions, including the single largest solid portion, solid proportion, and summated multiple solid portion measurements.
The cases of a total of 345 patients with surgically resected stage IA adenocarcinomas manifesting as PSNs were retrospectively reviewed. The multiplicity of the solid portion in PSNs was determined and the diameter of each solid portion was measured. The prognostic implication of the multiplicity of the solid portion and other clinical variables in relation to disease-free survival (DFS) was analyzed by using Cox regression. In addition, risk stratification based on the single largest solid portion, sum of the solid portions, single solid proportion, and sum of the solid proportions was conducted. Next, concordance indices (C-indices) for DFS were obtained for each measure and compared. Intrareader and interreader measurement variability was assessed.
Multiplicity of the solid portion did not have a significant effect on DFS; clinical T category was the only independent risk factor for tumor recurrence (p < 0.05). The C-index of the single solid portion (conventional clinical T category) was 0.817 (95% confidence interval: 0.691-0.942). There were no significant differences (p > 0.05) between the C-indices of the single solid portion and other solid portion measures. Interreader measurement variability was substantial.
The current clinical T categorization of PSNs based on the single solid portion measurement is appropriate.
本研究旨在分析 CT 扫描中部分实性结节（PSN）实性部分的多发性对预后的影响，并比较各种实性部分测量方法（包括最大实性部分、实性比例和多个实性部分总和测量）的预后性能。
回顾性分析了 345 例手术切除的 IA 期腺癌表现为 PSN 的患者。确定 PSN 中实性部分的多发性，并测量每个实性部分的直径。采用 Cox 回归分析了实性部分的多发性与其他临床变量与无病生存（DFS）的关系。此外，基于最大实性部分、实性部分总和、单个实性比例和实性部分总和进行了风险分层。然后，为每个测量值获得 DFS 的一致性指数（C 指数）并进行比较。评估了内部和内部读者测量的变异性。
实性部分的多发性对 DFS 没有显著影响；临床 T 分期是肿瘤复发的唯一独立危险因素（p < 0.05）。单一实性部分（传统临床 T 分期）的 C 指数为 0.817（95%置信区间：0.691-0.942）。单一实性部分与其他实性部分测量值的 C 指数之间没有显著差异（p > 0.05）。内部读者测量的变异性很大。
目前基于单一实性部分测量的 PSN 临床 T 分期是合适的。
