Thorac Cardiovasc Surg 2022; 70(03): 265-272
DOI: 10.1055/s-0039-1694061
Original Thoracic

Volume-Based Consolidation-to-Tumor Ratio Is a Useful Predictor for Postoperative Upstaging in Stage I and II Lung Adenocarcinomas

1   Department of General Thoracic Surgery, Ayabe City Hospital, Ayabe, Japan
,
Masashi Iwasaki
1   Department of General Thoracic Surgery, Ayabe City Hospital, Ayabe, Japan
,
Shunta Ishihara
2   Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
Masayoshi Inoue
2   Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
› Institutsangaben

Abstract

Background We investigated the postoperative upstaging of stage I and II lung adenocarcinoma patients to identify useful predictors for accurate staging.

Methods We retrospectively reviewed data from 80 consecutive patients undergoing lobectomy and mediastinal lymph node dissection for clinical stage I and II lung adenocarcinomas. We evaluated clinical variables, including the preoperative serum carcinoembryonic antigen (CEA), tumor diameter, consolidation-to-tumor ratio (CTR), maximum standardized uptake value (SUVmax) on FDG- PET, expression of epithelial growth factor receptor mutations, and pathological invasion to the pleura (pl), lymph duct (ly), and vein (v).

Results Eleven patients (13.8%) showed postoperative upstaging. Three cases had pN1 migrating from cN0, four cases had pN2 from cN0, and four cases showed malignant pleural effusion. The CEA level and CTR were significantly higher in the upstaging group. The tumors in the upstaging group showed more frequent pathological invasion to the visceral pleura and vein. In patients with 3 cm or smaller consolidation, two-dimensional (2D)-CTR and volume-based CTR were independent predictors of upstaging.

Conclusions Volume-based CTR could be a useful predictor for accurate clinical staging in stage I and II adenocarcinoma patients in addition to consolidation size, serum CEA level, and 2D-CTR. Both volume-based and 2D-CTRs might be especially useful in T1 diseases.



Publikationsverlauf

Eingereicht: 25. Juli 2018

Angenommen: 28. Juni 2019

Artikel online veröffentlicht:
08. August 2019

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Asamura H, Nakayama H, Kondo H, Tsuchiya R, Shimosato Y, Naruke T. Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy?. J Thorac Cardiovasc Surg 1996; 111 (06) 1125-1134
  • 2 Kim HK, Choi YS, Kim J, Shim YM, Kim K. Outcomes of unexpected pathologic N1 and N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 2010; 140 (06) 1288-1293
  • 3 Koike T, Koike T, Yamato Y, Yoshiya K, Toyabe S. Predictive risk factors for mediastinal lymph node metastasis in clinical stage IA non-small-cell lung cancer patients. J Thorac Oncol 2012; 7 (08) 1246-1251
  • 4 Park SY, Yoon JK, Park KJ, Lee SJ. Prediction of occult lymph node metastasis using volume-based PET parameters in small-sized peripheral non-small cell lung cancer. Cancer Imaging 2015; 15: 21
  • 5 Yang CF, Kumar A, Gulack BC. et al. Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: a National Cancer Data Base analysis. J Thorac Cardiovasc Surg 2016; 151 (05) 1380-1388
  • 6 Wang H, Zhou Z, Li Y. et al. Comparison of machine learning methods for classifying mediastinal lymph node metastasis of non-small cell lung cancer from 18F-FDG PET/CT images. EJNMMI Res 2017; 7 (01) 11
  • 7 Okamoto T, Iwata T, Mizobuchi T. et al. Pulmonary resection for lung cancer with malignant pleural disease first detected at thoracotomy. Eur J Cardiothorac Surg 2012; 41 (01) 25-30
  • 8 Ren YJ, She YL, Dai CY, Jiang GN, Fei K, Chen C. Primary tumour resection showed survival benefits for non-small-cell lung cancers with unexpected malignant pleural dissemination. Interact Cardiovasc Thorac Surg 2016; 22 (03) 321-326
  • 9 Billé A, Pelosi E, Skanjeti A. et al. Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg 2009; 36 (03) 440-445
  • 10 Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: are two better than one in mediastinal staging of non-small cell lung cancer?. J Thorac Cardiovasc Surg 2014; 148 (04) 1169-1177
  • 11 Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and safety of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration in mediastinal lymph node sampling: systematic review and meta-analysis. Respir Care 2015; 60 (07) 1040-1050
  • 12 Navani N, Nankivell M, Lawrence DR. et al; Lung-BOOST trial investigators. Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial. Lancet Respir Med 2015; 3 (04) 282-289
  • 13 Vilmann P, Clementsen PF, Colella S. et al. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy 2015; 47 (06) 545-559
  • 14 Goldstraw P, Chansky K, Crowley J. et al; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions, International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Advisory Boards and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11 (01) 39-51
  • 15 R_Core_Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2017
  • 16 Li S, Zheng Q, Ma Y. et al. Implications of false negative and false positive diagnosis in lymph node staging of NSCLC by means of 18F-FDG PET/CT. PLoS One 2013; 8 (10) e78552
  • 17 Nitadori J, Bograd AJ, Morales EA. et al. Preoperative consolidation-to-tumor ratio and SUVmax stratify the risk of recurrence in patients undergoing limited resection for lung adenocarcinoma ≤2 cm. Ann Surg Oncol 2013; 20 (13) 4282-4288
  • 18 Tsurugai Y, Kozuka T, Ishizuka N, Oguchi M. Relationship between the consolidation to maximum tumor diameter ratio and outcomes following stereotactic body radiotherapy for stage I non-small-cell lung cancer. Lung Cancer 2016; 92: 47-52
  • 19 Kudo Y, Matsubayashi J, Saji H. et al. Association between high-resolution computed tomography findings and the IASLC/ATS/ERS classification of small lung adenocarcinomas in Japanese patients. Lung Cancer 2015; 90 (01) 47-54
  • 20 Miyasaka Y, Suzuki K, Takamochi K, Matsunaga T, Oh S. The maximum standardized uptake value of fluorodeoxyglucose positron emission tomography of the primary tumour is a good predictor of pathological nodal involvement in clinical N0 non-small-cell lung cancer. Eur J Cardiothorac Surg 2013; 44 (01) 83-87
  • 21 Horeweg N, van Rosmalen J, Heuvelmans MA. et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol 2014; 15 (12) 1332-1341
  • 22 Scholten ET, de Jong PA, Jacobs C. et al. Interscan variation of semi-automated volumetry of subsolid pulmonary nodules. Eur Radiol 2015; 25 (04) 1040-1047
  • 23 Takenaka T, Yamazaki K, Miura N, Mori R, Takeo S. The prognostic impact of tumor volume in patients with clinical stage IA non-small cell lung cancer. J Thorac Oncol 2016; 11 (07) 1074-1080