426P - Combined radiologic imaging modalities for prognosis of clinical IA adenocarcinomas
|Date||18 December 2016|
|Event||ESMO Asia 2016 Congress|
|Topics|| Non-Small-Cell Lung Cancer, Early Stage
Imaging, Diagnosis and Staging
|Citation||Annals of Oncology (2016) 27 (suppl_9): ix134-ix135. 10.1093/annonc/mdw592|
H. Kuroda1, H. Tanaka2, T. Mizumo1, N. Sakakura1, T. Yoshida3, Y. Yatabe4, H. Iwata2, Y. Sakao1
We previously proposed measuring tumor size using mediastinal window setting on high-resolution computed tomography (CT) as a simple and useful modality for preoperative prognostication of small adenocarcinoma. Here, the importance of tumor volume and positron emission tomography (PET) for preoperative prognostication of clinical stage IA (cIA) adenocarcinoma for anatomical pulmonary resection was studied.
We retrospectively evaluated total 326 patients who underwent pulmonary resection of cIA adenocarcinoma between July 2008 and August 2015. Reconstructed three-dimensional (3D) images from 1–1.5 mm-slice multi-detector row CT were evaluated for tumor total volume (TTV), consolidation volume (CV) on lung window setting, and mediastinal volume (MV) on MWS. The values examined by PET were total lesion glycolysis, maximum standardized uptake (SUV max), and mean SUV. Patient age, gender, preoperative CEA levels, and clinical staging were examined. Pathologic status was evaluated according to tumor size (PS), invasive size (IS), lymphatic and vascular vessels, pleural invasion, and TNM staging.
Pathologic lymph node positivity, and IS were equivalent or superior to 3D imaging factors, preoperative patient variables, and PS, respectively. We used mean/MV to evaluate tumor quality and quantity, because only MV and CV were equivalent to IS. AUCs for mean/MV were 0.80, 0.82, and 0.81 and were ≥IS. Mean/MV was associated with lymph node metastasis, tumor invasiveness, histologic grade, and two-dimensional mediastinal diameter on MDCT. Among the various histologic subtypes, solid-predominant tumors had the highest mean/MV; the number of genomic triple-negative adenocarcinoma was significantly higher than adenocarcinoma harboring an exclusive gene of EGFR, KRAS, or ALK. Moreover, higher mean/MV significantly contributed to unfavorable disease-free survival in cIA adenocarcinomas.
The mean/MV value determination on 3D-reconstructed CT images was a simple and useful preoperative modality for predicting invasiveness, lymph node metastasis, and stage migration in cIA adenocarcinomas; higher values correlated with poorer prognosis and reflected tumor aggressiveness and extent of invasion.
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All authors have declared no conflicts of interest.