Fan Xin, Liang Chen, Ma Xueqin, Li Qi
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (X.F., Q.L.).
Department of Radiology, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China (C.L.).
Acad Radiol. 2025 Jan;32(1):450-459. doi: 10.1016/j.acra.2024.07.003. Epub 2024 Jul 22.
This study aimed to investigate the association of clinical, imaging, and pathological-molecular characteristics with the prediction of patient prognosis with stage IA invasive lung adenocarcinoma (ILADC) after sub-lobar resection.
This study assessed 360 patients, including 91 and 269 with and without recurrence 3 years postoperatively, respectively, with stage IA ILADC undergoing preoperative chest computed tomography (CT) scans and subsequent sub-lobar resection at our institution. Their clinical and CT features and histological subtypes and gene mutation status were compared. Binary logistic regression analysis was conducted to identify the independent risk factors for recurrence. An external validation cohort included 113 patients, used to test the model's efficiency.
For clinical features, old age, male gender, smokers, and high age-adjusted Charlson comorbidity index (ACCI) were frequently observed in patients with recurrence than those without (all p < 0.05). For CT features, large tumor size, solid-predominant density, spiculation, peripheral fibrosis, type II pleural tag, and pleural adhesion were more common in recurrent patients than non-recurrent ones (all p < 0.05). The regression model revealed old age, large tumor size, solid-predominant density, spiculation, type II pleural tag, and pleural adhesion as independent risk factors for recurrence, with an area under the curve (AUC) of 0.942. The external validation cohort obtained an AUC of 0.958. For phological-molecular features, micropapillary/solid-predominant growth pattern, KRAS, ALK, and NRAS mutation or fusion were more common in the recurrent group, whereas EGFR mutation was more frequent in the non-recurrent group (all p < 0.05).
Clinical and CT features help predict the prognosis of patients with stage IA ILADC after sub-lobar resection and decide for individualized treatment. Moreover, patients with different prognosis demonstrated different pathological-molecular features.
本研究旨在探讨临床、影像及病理分子特征与肺叶下切除术后IA期浸润性肺腺癌（ILADC）患者预后预测的相关性。
本研究评估了360例IA期ILADC患者，其中91例和269例分别在术后3年有和无复发，这些患者在我院接受了术前胸部计算机断层扫描（CT）及随后的肺叶下切除。比较了他们的临床和CT特征、组织学亚型及基因突变状态。进行二元逻辑回归分析以确定复发的独立危险因素。一个外部验证队列包括113例患者，用于检验模型的有效性。
对于临床特征，复发患者比未复发患者更常出现老年、男性、吸烟者及高年龄校正查尔森合并症指数（ACCI）（所有p<0.05）。对于CT特征，复发患者比未复发患者更常见肿瘤体积大、实性为主密度、毛刺征、外周纤维化、II型胸膜尾征及胸膜粘连（所有p<0.05）。回归模型显示老年、肿瘤体积大、实性为主密度、毛刺征、II型胸膜尾征及胸膜粘连是复发的独立危险因素，曲线下面积（AUC）为0.942。外部验证队列的AUC为0.958。对于病理分子特征，微乳头/实性为主生长模式、KRAS、ALK和NRAS突变或融合在复发组更常见，而EGFR突变在未复发组更频繁（所有p<0.05）。
临床和CT特征有助于预测肺叶下切除术后IA期ILADC患者的预后并决定个体化治疗。此外，不同预后的患者表现出不同的病理分子特征。
