Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Institute of Health and Environment, Seoul National University, Seoul, Korea.
AJR Am J Roentgenol. 2023 Oct;221(4):471-484. doi: 10.2214/AJR.23.29285. Epub 2023 May 31.
Pathologic extranodal extension (ENE) in metastatic lymph nodes (LNs) has been associated with unfavorable prognosis in patients with non-small cell lung cancer (NSCLC). The purpose of this article was to evaluate the prognostic utility of radiologic ENE and its diagnostic performance in predicting pathologic ENE in patients with NSCLC. This retrospective study included 382 patients (mean age, 67 ± 10 [SD] years; 297 men, 85 women) diagnosed with NSCLC and clinical N1 or N2 disease between January 2010 and December 2016. Two thoracic radiologists reviewed staging chest CT examinations to record subjective overall impression for radiologic ENE (no ENE, possible/probable ENE, or unambiguous ENE), reviewing 30 examinations in consensus and the remaining examinations independently. Kaplan-Meier survival analysis and multivariable Cox proportional hazards model were used to evaluate the utility of radiologic ENE in predicting overall survival (OS). Prognostic utility of radiologic ENE was also assessed in patients with clinical N2a disease. In patients who underwent surgery, sensitivity and specificity were determined of radiologic unambiguous ENE in predicting pathologic ENE. The 5-year OS rates for no ENE, possible/probable ENE, and unambiguous ENE were 44.4%, 39.1%, and 20.9% for reader 1 and 45.7%, 36.6%, and 25.6% for reader 2, respectively. Unambiguous ENE was an independent prognostic factor for worse OS (reader 1: adjusted HR, 1.72, = .008; reader 2: adjusted HR, 1.56, = .03), whereas possible/probable ENE was not (reader 1: adjusted HR, 1.18, = .33; reader 2: adjusted HR, 1.21, = .25). In patients with clinical N2a disease, 5-year OS rate in patients with versus without unambiguous ENE for reader 1 was 22.2% versus 40.6% ( = .59) and for reader 2 was 27.6% versus 41.0% ( = .49). In 203 patients who underwent surgery (66 with pathologic ENE), sensitivity and specificity of radiologic unambiguous ENE for predicting pathologic ENE were 11% and 93% for reader 1 and 23% and 87% for reader 2. Radiologic unambiguous ENE was an independent predictor of worse OS in patients with NSCLC. The finding had low sensitivity but high specificity for pathologic ENE. Radiologic ENE may have a role in NSCLC staging workup and treatment selection.
病理淋巴结外扩展（ENE）在转移性淋巴结（LNs）中与非小细胞肺癌（NSCLC）患者的不良预后相关。本文的目的是评估放射学ENE 的预后实用性及其在预测 NSCLC 患者病理 ENE 中的诊断性能。这项回顾性研究纳入了 382 名（平均年龄 67 ± 10 [SD] 岁；297 名男性，85 名女性）诊断为 NSCLC 且临床 N1 或 N2 疾病的患者，其疾病诊断时间为 2010 年 1 月至 2016 年 12 月。两位胸部放射科医生回顾了分期胸部 CT 检查，以记录放射学 ENE 的主观总体印象（无 ENE、可能/可能有 ENE 或明确有 ENE），对 30 次检查进行了一致性回顾，其余检查则分别进行了回顾。使用 Kaplan-Meier 生存分析和多变量 Cox 比例风险模型来评估放射学 ENE 在预测总生存（OS）方面的实用性。在临床 N2a 疾病患者中还评估了放射学 ENE 的预后实用性。对于接受手术的患者，确定了放射学明确 ENE 预测病理 ENE 的灵敏度和特异性。无 ENE、可能/可能有 ENE 和明确有 ENE 的患者 5 年 OS 率分别为 1 号读者组的 44.4%、39.1%和 20.9%，2 号读者组的 45.7%、36.6%和 25.6%。明确的 ENE 是 OS 更差的独立预后因素（1 号读者：调整后的 HR，1.72， =.008；2 号读者：调整后的 HR，1.56， =.03），而可能/可能有 ENE 则不是（1 号读者：调整后的 HR，1.18， =.33；2 号读者：调整后的 HR，1.21， =.25）。在临床 N2a 疾病患者中，1 号读者中明确有 ENE 患者与无明确 ENE 患者的 5 年 OS 率分别为 22.2%与 40.6%（ =.59），2 号读者中分别为 27.6%与 41.0%（ =.49）。在 203 名接受手术的患者（66 名有病理 ENE）中，1 号读者和 2 号读者的放射学明确 ENE 预测病理 ENE 的灵敏度和特异性分别为 11%和 93%、23%和 87%。放射学明确的 ENE 是 NSCLC 患者 OS 更差的独立预测因子。该发现对病理 ENE 具有低敏感性但高特异性。放射学 ENE 可能在 NSCLC 分期检查和治疗选择中发挥作用。
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