Setojima Yusuke, Shimada Yoshihisa, Tanaka Takehiko, Shigefuku Shunsuke, Makino Yojiro, Maehara Sachio, Hagiwara Masaru, Masuno Ryuichi, Yamada Takafumi, Kakihana Masatoshi, Kajiwara Naohiro, Ohira Tatsuo, Ikeda Norihiko
Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan.
Eur J Cardiothorac Surg. 2020 Apr 1;57(4):763-770. doi: 10.1093/ejcts/ezz305.
The measurement of part-solid and whole tumour sizes in patients with non-small-cell lung cancer (NSCLC) using computed tomography (CT) has been widely accepted for assessing clinical outcomes. Although the volume doubling time (VDT) of a tumour is useful for distinguishing high-risk nodules from low-risk ones, it remains to be clarified whether separate calculation of whole-tumour VDT and solid-part tumour VDT (SVDT) greatly affects the survival rate of patients with radiologically node-negative part-solid or solid NSCLC.
The study included 258 patients with NSCLC who had radiologically node-negative, part-solid or solid tumours and who had at least 2 preoperative CT scans taken more than 30 days apart followed by radical lobectomy and systemic lymph node dissection between January 2012 and December 2015. Univariable and multivariable analyses of recurrence-free survival were performed using the Cox proportional hazards regression model.
The mean whole-tumour VDT and SVDT were 375 and 458 days, respectively. Multivariable analyses demonstrated that whole-tumour VDT (P = 0.003), SVDT (P < 0.001), solid-part tumour size, whole-tumour size and comorbidities significantly affected the recurrence-free survival. Using the receiver operating characteristic curve, the cut-off value of the SVDT for recurrence was 215 days, and the 5-year recurrence-free survival rates for patients with SVDT >215 days and those with SVDT <215 days were 85.7% and 43.0%, respectively (P < 0.001).
The calculation of SVDT in patients with node-negative, part-solid or solid NSCLC is highly useful for predicting postoperative survival outcomes.
使用计算机断层扫描（CT）测量非小细胞肺癌（NSCLC）患者的部分实性和整个肿瘤大小已被广泛用于评估临床结局。尽管肿瘤的体积倍增时间（VDT）有助于区分高危结节和低危结节，但对于放射学上淋巴结阴性的部分实性或实性NSCLC患者，单独计算整个肿瘤的VDT和实性部分肿瘤的VDT（SVDT）是否会极大影响患者生存率仍有待阐明。
该研究纳入了258例NSCLC患者，这些患者放射学上淋巴结阴性、肿瘤为部分实性或实性，且在2012年1月至2015年12月期间至少有2次间隔超过30天的术前CT扫描，随后接受根治性肺叶切除术和系统性淋巴结清扫。使用Cox比例风险回归模型对无复发生存进行单变量和多变量分析。
整个肿瘤的平均VDT和SVDT分别为375天和458天。多变量分析表明，整个肿瘤的VDT（P = 0.003）、SVDT（P < 0.001）、实性部分肿瘤大小、整个肿瘤大小和合并症显著影响无复发生存。使用受试者工作特征曲线，SVDT复发的临界值为215天，SVDT>215天和SVDT<215天患者的5年无复发生存率分别为85.7%和43.0%（P < 0.001）。
对于淋巴结阴性、部分实性或实性NSCLC患者，计算SVDT对预测术后生存结局非常有用。
