Jeon Jae Hyun, Lee Joonseok, Park Jong Sun, Park In Kyu, Jang Sowon, Son Jung Woo, Jung Woohyun, Cho Sukki, Kim Kwhanmien
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea.
J Clin Med. 2025 Aug 9;14(16):5640. doi: 10.3390/jcm14165640.
: This study evaluated the prognostic significance of quantitatively assessed interstitial lung abnormalities (ILAs) after lung cancer surgery. We included patients with pathologic stage I non-small-cell lung cancer (NSCLC) who underwent segmentectomy or lobectomy. ILAs were quantified using deep learning texture analysis software. Five-year overall survival (OS) was compared before and after propensity score matching. Competing risks for lung cancer and non-cancer mortality were also analyzed. Among the 1711 patients, 263 (15.4%) comprised the ILA group. The ILA group was older and had a higher proportion of smokers and pathologic stage IB cases (all < 0.001). The median follow-up period was 48.0 months. Before matching, 5-year OS was significantly worse in the ILA group than in the non-ILA group (82.5% vs. 93.4%, < 0.001). After 2:1 matching ( = 697), 5-year OS remained lower in the ILA group (85.8% vs. 91.1%, = 0.025). Multivariable Cox regression analysis showed that the presence of ILAs was associated with increased risk of all-cause mortality (HR 1.52, 95% CI 1.05-2.18, = 0.025). Restricted cubic spline analysis revealed a nonlinear increase in mortality risk with greater fibrotic ILA burden. In competing risk analysis, death from lung cancer was similar between groups (2.9% vs. 4.2%, = 0.3), whereas death from other causes was significantly higher in the ILA group (13.0% vs. 3.7%, < 0.001). Quantitative assessment of ILAs may provide prognostic value in resected stage I NSCLC, particularly in patients with fibrotic changes.
本研究评估了肺癌手术后定量评估的间质性肺异常（ILA）的预后意义。我们纳入了接受肺段切除术或肺叶切除术的病理I期非小细胞肺癌（NSCLC）患者。使用深度学习纹理分析软件对ILA进行量化。在倾向评分匹配前后比较了5年总生存率（OS）。还分析了肺癌和非癌症死亡的竞争风险。在1711例患者中，263例（15.4%）组成ILA组。ILA组患者年龄更大，吸烟者和病理IB期病例的比例更高（均<0.001）。中位随访期为48.0个月。匹配前，ILA组的5年OS明显低于非ILA组（82.5%对93.4%，<0.001）。在2:1匹配（n = 697）后，ILA组的5年OS仍然较低（85.8%对91.1%，P = 0.025）。多变量Cox回归分析显示，ILA的存在与全因死亡风险增加相关（HR 1.52，95%CI 1.05 - 2.18，P = 0.025）。受限立方样条分析显示，随着纤维化ILA负担加重，死亡风险呈非线性增加。在竞争风险分析中，两组间肺癌死亡情况相似（2.9%对4.2%，P = 0.3），而ILA组其他原因导致的死亡明显更高（13.0%对3.7%，<0.001）。ILA的定量评估可能为I期NSCLC切除术后提供预后价值，特别是在有纤维化改变的患者中。
