The impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity

doi:10.3877/cma.j.issn.2095-8773.2018.04.03

Abstract

Abstract:

Objective

The purpose of this study is to evaluate the impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity.

Methods

We reviewed the clinical data of 3254 surgically resected c-stage I lung cancer patients, 312 (9.6%)with multiple lung tumors. All patients were classified into 3 groups based on the extent of ground glass opacity (GGO) and consolidation tumor ratio (CTR), including GGO-dominant (GD)(0 ≤CTR < 0.5), solid-dominant (SD) (0.5 ≤CTR < 1.0) , and pure-solid (PS) (CTR =1.0). Patients with multiple lung tumors were divided into 6 groups based on imaging findings, including GD+ GD group, GD+ SD group, GD+ PS group, SD+ SD group, SD+ PS group and PS+ PS group , and their prognoses were compared with that of c-stage I lung cancer using Cox’s proportional hazard model.

Results

Among all, 251(80.4%) have surgically resected more than two tumors and pathologically determined as multiple lung cancers patients . Among 312 patients , 90 in GD+ GD group (28.8%), 70 in GD + SD group(22.4%), 66 in GD+ PS group(21.2%), 16 in SD + SD group(5.1%), 27 in SD+ PS group(8.7%), and 43 in PS + PS group(13.8%). Based on the results of multivariate analyses, PS+ PS revealed the independent risk factors for prognosis impact(P<0.001). The overall survival rate (OS) was 96.7% in group GD+ GD, 98.6% in group GD + SD, 84.8% in group GD+ PS , 93.8% in group SD+ SD , 77.8% in group SD+ PS , 41.9% in group PS + PS , which showing a significant difference between PS+ PS group and the other groups (P<0.05).

Conclusions

Among all patients with multiple lung cancers, patients in PS+ PS group have lower survival rate, which would contribute to the upstaging of T descriptors. The imaging findings of GGO and its classifications are extremely important to prognosis evaluation.

Key words: Multiple lung cancers, Ground glass opacity, Imaging findings, Prognosis

Yulong Xuan, Minke Shi. The impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(04): 213-218.

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病理学特点		GD＋GD组(n＝90)	GD＋SD组( n＝70)	GD＋PS组( n＝66)	SD＋SD组( n＝16)	SD＋PS组( n＝27)	PS＋PS组( n＝43)	P值
p-N(N1/N2)		0(0)/0(0)	0(0)/4(5.7)	6(9.1)(0)/6(9.1)	0(0)/1(6.3)	5(18.5)/5(18.5)	6(14)/10(23.3)	<0.001
病理分期		?	?	?	?	?	?	?
?	ⅠA/ⅠB期	89(98.9)/1(1.1)	53(75.5)/13(18.6)	48(72.7)/8(12.1)	7(43.8)/6(37.5)	12(44.4)/4(14.8)	8(18.6)/10(23.3)	<0.001
?	ⅡA/ⅡB期	0(0)/0(0)	0(0)/1(1.4)	5(7.6)/2(3.0)	1(6.3)/1(6.3)	5(18.5)/2(7.4)	9(20.9)/3(7)	?
?	ⅢA/ⅢB期	0(0)/0(0)	3(4.3)/0	3(4.5)/0(0)	1(6.3)/0(0)	4(14.8)/0(0)	8(18.6)/0(0)	?
?	Ⅳ期	0(0)	0(0)	0(0)	0(0)	0(0)	5(11.6)	?
组织学表现		?	?	?	?	?	?	?
?	多原发性肺癌	82(91.1)	39(55.7)	45(68.2)	16(100)	26(96.3)	34(79.1)	<0.001
?	肺内转移	0(0)	0(0)	0(0)	0(0)	1(3.7)	9(20(0).9)	?
组织学类型		?	?	?	?	?	?	?
?	腺癌	7(7.8)	31(44.3)	22(33.3)	0(0)	0(0)	0(0)	<0.001
?	多发腺癌	83(92.2)	39(45.7)	39(59.1)	16(100)	26(96.3)	22(51.2)	?
?	鳞癌	0(0)	0(0)	1(1.5)	0(0)	0(0)	0(0)	?
?	多发鳞癌	0(0)	0(0)	0(0)	0(0)	0(0)	6(14)	?
?	腺癌＋鳞癌	0(0)	0(0)	2(3.0)	0(0)	1(3.7)	11(25.6)	?
?	腺癌＋腺样鳞形细胞癌	0(0)	0(0)	2(3.0)	0(0)	0(0)	2(7.4)	?
?	腺癌＋大细胞神经内分泌癌	0(0)	0(0)	0(0)	0(0)	0(0)	2(7.4)	?
EGFR突变		23(25.6)	31(44.3)	28(42.4)	8(50)	16(59.3)	14(32.6)	0.043
侵犯淋巴管		1(1.1)	11(15.7)	22(33.3)	5(31.3)	9(33.3)	18(41.9)	<0.001
侵犯血管		1(1.1)	6(8.6)	20(30.3)	3(18.8)	8(29.6)	24(55.8)	<0.001
新辅助化疗		10(11.1)	18(25.7)	16(24.2)	1(6.3)	8(29.6)	16(37.2)	0.025

病理学特点		GD＋GD组(n＝90)	GD＋SD组( n＝70)	GD＋PS组( n＝66)	SD＋SD组( n＝16)	SD＋PS组( n＝27)	PS＋PS组( n＝43)	P值
p-N(N1/N2)		0(0)/0(0)	0(0)/4(5.7)	6(9.1)(0)/6(9.1)	0(0)/1(6.3)	5(18.5)/5(18.5)	6(14)/10(23.3)	<0.001
病理分期		?	?	?	?	?	?	?
?	ⅠA/ⅠB期	89(98.9)/1(1.1)	53(75.5)/13(18.6)	48(72.7)/8(12.1)	7(43.8)/6(37.5)	12(44.4)/4(14.8)	8(18.6)/10(23.3)	<0.001
?	ⅡA/ⅡB期	0(0)/0(0)	0(0)/1(1.4)	5(7.6)/2(3.0)	1(6.3)/1(6.3)	5(18.5)/2(7.4)	9(20.9)/3(7)	?
?	ⅢA/ⅢB期	0(0)/0(0)	3(4.3)/0	3(4.5)/0(0)	1(6.3)/0(0)	4(14.8)/0(0)	8(18.6)/0(0)	?
?	Ⅳ期	0(0)	0(0)	0(0)	0(0)	0(0)	5(11.6)	?
组织学表现		?	?	?	?	?	?	?
?	多原发性肺癌	82(91.1)	39(55.7)	45(68.2)	16(100)	26(96.3)	34(79.1)	<0.001
?	肺内转移	0(0)	0(0)	0(0)	0(0)	1(3.7)	9(20(0).9)	?
组织学类型		?	?	?	?	?	?	?
?	腺癌	7(7.8)	31(44.3)	22(33.3)	0(0)	0(0)	0(0)	<0.001
?	多发腺癌	83(92.2)	39(45.7)	39(59.1)	16(100)	26(96.3)	22(51.2)	?
?	鳞癌	0(0)	0(0)	1(1.5)	0(0)	0(0)	0(0)	?
?	多发鳞癌	0(0)	0(0)	0(0)	0(0)	0(0)	6(14)	?
?	腺癌＋鳞癌	0(0)	0(0)	2(3.0)	0(0)	1(3.7)	11(25.6)	?
?	腺癌＋腺样鳞形细胞癌	0(0)	0(0)	2(3.0)	0(0)	0(0)	2(7.4)	?
?	腺癌＋大细胞神经内分泌癌	0(0)	0(0)	0(0)	0(0)	0(0)	2(7.4)	?
EGFR突变		23(25.6)	31(44.3)	28(42.4)	8(50)	16(59.3)	14(32.6)	0.043
侵犯淋巴管		1(1.1)	11(15.7)	22(33.3)	5(31.3)	9(33.3)	18(41.9)	<0.001
侵犯血管		1(1.1)	6(8.6)	20(30.3)	3(18.8)	8(29.6)	24(55.8)	<0.001
新辅助化疗		10(11.1)	18(25.7)	16(24.2)	1(6.3)	8(29.6)	16(37.2)	0.025

因素	单变量		多变量
因素	HR(95% CI)	P值	HR(95% CI)	P值
慢性阻塞性肺部疾病	0.938(0.334～2.397)	0.905	?	?
血癌胚抗原数值(ng/ml)	1.058(1.003～1.085)	0.003	1.016(0.916～1.078)	0.295
最大肿瘤直径(mm)	1.086(1.043～1.112)	<0.001	1.025(0.957～1.078)	0.183
影像学分类(PS ＋ PS)	11.34(5.127～22.34)	<0.001	6.324(0.095～0.579)	0.003
行肺叶切除术	14.12(1.835～97.34)	0.015	5.572(0.734～45.72)	0.095
腺癌	0.428(0.213～1.127)	0.083	?	?
累及淋巴结	0.144(0.068～0.375)	<0.001	0.397(0.146～0.994)	0.047
累及淋巴管	0.239(0.115～0.512)	<0.001	0.975(0.384～2.495)	0.968
新辅助化疗	0.548(0.264～1.170)	1.127	?	?

因素	单变量		多变量
因素	HR(95% CI)	P值	HR(95% CI)	P值
慢性阻塞性肺部疾病	0.938(0.334～2.397)	0.905	?	?
血癌胚抗原数值(ng/ml)	1.058(1.003～1.085)	0.003	1.016(0.916～1.078)	0.295
最大肿瘤直径(mm)	1.086(1.043～1.112)	<0.001	1.025(0.957～1.078)	0.183
影像学分类(PS ＋ PS)	11.34(5.127～22.34)	<0.001	6.324(0.095～0.579)	0.003
行肺叶切除术	14.12(1.835～97.34)	0.015	5.572(0.734～45.72)	0.095
腺癌	0.428(0.213～1.127)	0.083	?	?
累及淋巴结	0.144(0.068～0.375)	<0.001	0.397(0.146～0.994)	0.047
累及淋巴管	0.239(0.115～0.512)	<0.001	0.975(0.384～2.495)	0.968
新辅助化疗	0.548(0.264～1.170)	1.127	?	?

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