Li Ying, Zhao Junfeng, Li Ruyue, Yao Xiujing, Dong Xue, Zhao Ying, Xia Zhongshuo, Xu Yali, Li Yintao
Department of Respiratory Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, and Shandong Academy of Medical Sciences, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, and Shandong Academy of Medical Sciences, Jinan, China.
Transl Lung Cancer Res. 2024 Oct 31;13(10):2585-2602. doi: 10.21037/tlcr-24-544. Epub 2024 Oct 28.
Patients with stage IA lung adenocarcinoma (ADC) with an micropapillary (MIP) component are at a higher risk of recurrence after radical surgical resection; however, adding adjuvant chemotherapy (ACT) to their postoperative course remains controversial. This study determined the predictive factors that influence the prognosis of these patients and identified those at high risk of recurrence.
Between January 2012 and December 2018, 254 eligible patients with stage IA lung ADC with an MIP component were categorized into training (n=169) and validation (n=85) cohorts. Clinicopathological and radiomics features were included in univariate and multivariate analyses, and statistically significant predictors were used to develop the nomogram. Area under the curve (AUC) of receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to validate the model. The calculated risk scores for each patient were risk-stratified using the X-tile procedure, and survival analyses were performed among the different risk subgroups.
T1c stage, MIP ≥1%, spread through air space (STAS), carcinoembryonic antigen (CEA) >5 µg/L, and radiomics features were independent predictors of overall survival (OS) and disease-free survival (DFS) in patients with lung ADC with an MIP component at stage IA. Incorporating this into the nomogram, the AUCs of the nomogram predicting 3-, 5-, and 7-year OS and DFS were 0.910, 0.914, and 0.904 and 0.868, 0.838, and 0.848, respectively, in the training cohort and 0.879, 0.895, and 0.899 and 0.817, 0.805, and 0.811, respectively, in the validation cohort, showing good differentiation. The OS and DFS survival analyses among different risk subgroups showed that the nomogram could well distinguish between low- and high-risk groups.
We developed and validated a nomogram based on clinicopathological factors and radiomics features, which can be used as a powerful tool for predicting postoperative recurrence and survival in patients with stage IA lung ADC containing an MIP component.
伴有微乳头（MIP）成分的IA期肺腺癌（ADC）患者在根治性手术切除后复发风险较高；然而，在其术后过程中加用辅助化疗（ACT）仍存在争议。本研究确定了影响这些患者预后的预测因素，并识别出复发高风险患者。
在2012年1月至2018年12月期间，将254例符合条件的伴有MIP成分的IA期肺ADC患者分为训练队列（n = 169）和验证队列（n = 85）。单因素和多因素分析纳入了临床病理和影像组学特征，并使用具有统计学意义的预测因素来构建列线图。采用受试者操作特征（ROC）曲线的曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）来验证模型。使用X-tile程序对每位患者计算的风险评分进行风险分层，并在不同风险亚组中进行生存分析。
T1c期、MIP≥1%、气腔播散（STAS）、癌胚抗原（CEA）>5μg/L以及影像组学特征是伴有MIP成分的IA期肺ADC患者总生存（OS）和无病生存（DFS）的独立预测因素。将这些因素纳入列线图，训练队列中列线图预测3年、5年和7年OS和DFS的AUC分别为0.910、0.914和0.904以及0.868、0.838和0.848，验证队列中分别为0.879、0.895和0.899以及0.817、0.805和0.811，显示出良好的区分度。不同风险亚组之间的OS和DFS生存分析表明，列线图能够很好地区分低风险和高风险组。
我们基于临床病理因素和影像组学特征开发并验证了一种列线图，可作为预测伴有MIP成分的IA期肺ADC患者术后复发和生存的有力工具。
