So Hee Song1, Joong Hyun Ahn2, Ho Yun Lee3, Geewon Lee4, Joon Young Choi5, Jun Kang6, Eun Young Kim1, Joungho Han7, O Jung Kwon8, Kyung Soo Lee1, Hong Kwan Kim9, Yong Soo Choi9, Jhingook Kim9, Young Mog Shim9. 1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea. 2. Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea. 3. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea. hoyunlee96@gmail.com. 4. Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. rabkingdom@naver.com. 5. Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 6. Department of Pathology, Inchun St. Mary's Hospital, College of Medicine, Catholic University of Korea, Inchun, Korea. 7. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 8. Division of Respiratory and Critical Medicine of the Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 9. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Abstract
OBJECTIVES: Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-glass-opacity (GGO) portion on CT have different prognostic significance. Therefore, current T descriptor, defined as the whole tumour diameter without discrimination between solid and GGO, is insufficient. We aimed to determine the prognostic significance of solid tumour size and attempt to include prognostic factors such as tumour disappearance rate (TDR) on CT and SUVmax on PET/CT. METHODS: Five hundred and ninety-five patients with completely resected lung adenocarcinoma were analyzed. We developed a nomogram using whole tumour size, TDR, and SUVmax. External validation was performed in another 102 patients. RESULTS: In patients with tumours measuring ≤2 cm and >2 to 3 cm, disease free survival (DFS) was significantly associated with solid tumour size (P < 0.001), but not with whole tumour size (P = 0.052). Developed nomogram was significantly superior to the conventional T stage (area under the curve of survival ROC; P = 0.013 by net reclassification improvement) in stratification of patient survival. In the external validation group, significant difference was noted in DFS according to proposed T stage (P = 0.009). CONCLUSIONS: Nomogram-based T descriptors provide better prediction of survival and assessment of individual risks than conventional T descriptors. KEY POINTS: • Current measurement of whole tumour diameter including ground-glass opacity is insufficient • TDR enables differentiation between invasive solid portion and non-invasive GGO portion • SUVmax demonstrates the biological aggressiveness of the tumour • We developed a nomogram using whole tumour size, TDR, and SUVmax • Nomogram-based clinical T descriptors provide better prediction of survival.
OBJECTIVES:Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-glass-opacity (GGO) portion on CT have different prognostic significance. Therefore, current T descriptor, defined as the whole tumour diameter without discrimination between solid and GGO, is insufficient. We aimed to determine the prognostic significance of solid tumour size and attempt to include prognostic factors such as tumour disappearance rate (TDR) on CT and SUVmax on PET/CT. METHODS: Five hundred and ninety-five patients with completely resected lung adenocarcinoma were analyzed. We developed a nomogram using whole tumour size, TDR, and SUVmax. External validation was performed in another 102 patients. RESULTS: In patients with tumours measuring ≤2 cm and >2 to 3 cm, disease free survival (DFS) was significantly associated with solid tumour size (P < 0.001), but not with whole tumour size (P = 0.052). Developed nomogram was significantly superior to the conventional T stage (area under the curve of survival ROC; P = 0.013 by net reclassification improvement) in stratification of patient survival. In the external validation group, significant difference was noted in DFS according to proposed T stage (P = 0.009). CONCLUSIONS: Nomogram-based T descriptors provide better prediction of survival and assessment of individual risks than conventional T descriptors. KEY POINTS: • Current measurement of whole tumour diameter including ground-glass opacity is insufficient • TDR enables differentiation between invasive solid portion and non-invasive GGO portion • SUVmax demonstrates the biological aggressiveness of the tumour • We developed a nomogram using whole tumour size, TDR, and SUVmax • Nomogram-based clinical T descriptors provide better prediction of survival.
Authors: Ho Yun Lee; Joungho Han; Kyung Soo Lee; Ji Hyun Koo; Sun Young Jeong; Byung-Tae Kim; Young-Seok Cho; Young Mog Shim; Jhingook Kim; Kwanmien Kim; Yong Soo Choi Journal: Lung Cancer Date: 2009-03-18 Impact factor: 5.705
Authors: John H M Austin; Kavita Garg; Denise Aberle; David Yankelevitz; Keiko Kuriyama; Hyun-Ju Lee; Elisabeth Brambilla; William D Travis Journal: Radiology Date: 2012-10-15 Impact factor: 11.105
Authors: Ki Hwan Kim; Seong-Yoon Ryu; Ho Yun Lee; Joon Young Choi; O Jung Kwon; Hong Kwan Kim; Young Mog Shim Journal: Medicine (Baltimore) Date: 2019-07 Impact factor: 1.817