Park Ju Ae, Pham Duy, Wang Hongkun, Khandhar Sandeep, Weyant Michael J, Suzuki Kei
Department of Surgery, INOVA Fairfax Medical Center, Fairfax, VA, USA.
University of Virginia School of Medicine, Charlottesville, VA, USA.
J Thorac Dis. 2024 Oct 31;16(10):6475-6482. doi: 10.21037/jtd-24-923. Epub 2024 Oct 30.
As sub-lobar resection becomes acceptable for lung cancer ≤2 cm, a preoperative marker of tumor aggressiveness to choose an appropriate extent of resection becomes necessary. We sought to assess the utility of Computer-Aided Nodule Assessment and Risk Yield (CANARY), a validated radiomic tool, in clinical stage I adenocarcinoma ≤2 cm.
We performed a retrospective review of resected lung cancer patients from 2016-2022. Our eligibility criteria included clinical stage I adenocarcinoma, availability of pre-operative computed tomography (CT) imaging, and a lesion size of ≤2 cm. Preoperative imaging was input into the CANARY program, and this was then used to categorize each lesion into good, intermediate, and poor. Kaplan-Meier curve was used to compare the recurrence-free survival (RFS). Descriptive statistics and log-rank tests were conducted to compare RFS between risk groups.
Study population (n=134) had a median age of 68.6 and follow up of 2.9 years. By CANARY profile, 29 patients (21.6%) were good risk, 52 (38.8%) intermediate, and 53 (39.6%) poor. By procedure, 52 patients (38.8%) received wedge resections. Overall, the 3-year RFS was 96.3%, 92.0%, and 72.7% for patients with good, intermediate, and poor risks, respectively. There was a statistically significant difference in RFS between each risk group (χ=12.6, P=0.002). Patients with poor risk were associated with a significantly increased risk of recurrence relative to those with good/intermediate risks [hazard ratio (HR) =5.7, 95% confidence interval (CI): 1.9-17.5].
Poor risk on CANARY analysis is significantly associated with increased risk of recurrence after resection in clinical stage I adenocarcinoma lesions ≤2 cm.
随着亚肺叶切除术被认为适用于直径≤2 cm的肺癌，术前选择合适切除范围的肿瘤侵袭性标志物变得必要。我们试图评估经过验证的放射组学工具——计算机辅助结节评估与风险收益（CANARY）在直径≤2 cm的临床I期腺癌中的应用价值。
我们对2016年至2022年接受手术切除的肺癌患者进行了回顾性研究。我们的纳入标准包括临床I期腺癌、术前计算机断层扫描（CT）影像资料以及病灶大小≤2 cm。将术前影像资料输入CANARY程序，然后将每个病灶分为低风险、中风险和高风险。采用Kaplan-Meier曲线比较无复发生存期（RFS）。进行描述性统计和对数秩检验以比较风险组之间的RFS。
研究人群（n = 134）的中位年龄为68.6岁，随访时间为2.9年。根据CANARY分析结果，29例患者（21.6%）为低风险，52例（38.8%）为中风险，53例（39.6%）为高风险。按手术方式，52例患者（38.8%）接受了楔形切除术。总体而言，低风险、中风险和高风险患者的3年RFS分别为96.3%、92.0%和72.7%。各风险组之间的RFS存在统计学显著差异（χ = 12.6，P = 0.002）。与低风险/中风险患者相比，高风险患者的复发风险显著增加[风险比（HR）= 5.7，95%置信区间（CI）：1.9 - 17.5]。
在直径≤2 cm的临床I期腺癌病灶中，CANARY分析显示的高风险与切除术后复发风险增加显著相关。
