Stage Ⅰ A Invasive Adenocarcinoma:The Correlations Between CT Features And Pathological Classification And The Analysis Of Prognostic Factors In The Curatively Resected Cancer

Part I Stage la invasive adenocarcinoma:The correlations between CT features and pathological classification of lung adenocarcinomaPurposeThe CT imaging findings of stage la adenocarcinoma were retrospectively analyzed to evaluate the correlations between CT imaging features and 2015 WHO pathological classification of lung adenocarcinoma and to evaluate the accuracy of CT for pulmonary nodules pathological subtypes.Materials and MethodsFrom November 2014 to November 2018,130 pulmonary nodules pathologically confirmed were included in this study,including 30 pure ground glass nodules,61 mix ground glass nodules and 39 solid nodules.We divided the nodules into three groups according to the pathological classification:lepidic adenocarcinoma,acinar adenocarcinoma and others.The patient gender,age,imaging features(including lobulated shape,spiculated sign,marginal,vocule sign,pleural indentation sign)and nodular location,mean diameter,mean CT value,solid proportion were assessed.Pearson x 2 test,one-way ANOVA,Mann-Whitney U,Kruskal-wallis H were used to analyzed the variables.The variables that exhibited statistically significant differences were included in a binary logistic regression analysis.The ROC analysis of the variable with statistical significance in the binary logistic regression analysis,plots the ROC curve,and confirms the optimal cutoff value.ResultsWe divided 130 nodules into three groups according to the pathological classification:61 lepidic adenocarcinomas,42 acinar adenocarcinomas and 27 others.The mean CT value,solid component proportion,spiculated sign,lobulated shape and vocule sign were significantly different among the three groups(P<0.05).There were no significant differences among patient age,gender,nodular location,mean diameter,marginal,pleural indentation sign among the three groups(P>0.05).The results of binary logistic regression showed that lobulated shape and vocule sign were significantly different between lepidic adenocarcinoma and acinar adenocarcinoma(P<0.05).Vocule sign is more common in lepidic adenocarcinoma and lobulated shape is more common in acinar adenocarcinoma.There were 17 nodules with micropapillary component,and 113 nodules without micropapillary component.There is a noticeable difference in mean CT value and solid component proportion of the two groups(P<0.05).The results of binary logistic regression and ROC analysis revealed that mean CT value was an important factor in the difference between the two groups,the sensitivity and specificity of mean CT value(cutoff,0.242HU)were 76.6%and 80.5%.ConclusionLobulated shape and vocule sign are significant factors in differentiating lepidic adenocarcinoma from acinar adenocarcinoma.Vocule sign is more common in lepidic adenocarcinoma and lobulated shape is more common in acinar adenocarcinoma.Mean CT value is an significant factors in differentiating micropapillary component.The CT value of adenocarcinoma with micropapillary component is higher than adenocarcinoma without micropapillary component.Part II The analysis of prognostic factors in the curatively resected pathological stage I a lung adenocarcinomaPurposePatients with pathological stage la lung adenocarcinoma show variabilities in prognosis even after resection.Postoperative recurrence and metastasis are the main causes for failure treatment in early lung adenocarcinoma.The factors resulting in heterogeneities of prognosis remain controversy.The aim of this study was to identify the imaging factors affecting recurrence/metastasis and survival in patients with resected stage I lung adenocarcinoma.Materials and Methods68 patients with stage la lung adenocarcinoma were retrospectively reviewed in order to analyze the associations of recurrence and survival with following variables:age,gender,nodular location,mean diameter,mean CT value,solid proportion,surgical method,postoperative adjuvant treatment,micropapillary component,lepidic component and imaging features(including lobulated shape,spiculated sign,marginal,vocule sign,pleural indentation sign).SPSS 22.0 was used for statistical analysis.The variables that exhibited statistically significant differences were included in Cox multivariate proportional hazards regression.ROC analyses were conducted for the variables that exhibited statistically significant differences in the Cox multivariate proportional hazards regression,drew ROC curves,then the optimal cut-off values were confirmed.The disease-free survival was estimated using the Kaplan-Meier methods.ResultsAmong those 68 patients,7 had local recurrence or metastasis,the rest 61 patients had no relapse until the last follow-up.The mean CT value,marginal,spiculated sign,surgical method were significantly different between the two groups(P<0.15).Cox multivariate analysis revealed that mean CT value was significantly associated with disease-free survival.The ROC analysis showed that the sensitivity and specificity of mean CT value(cutoff,0.121HU)were 71.4%and 70.5%.ConclusionThe mean CT value could be considered as a factor for predicting survival in resected stage Ⅰ a lung adenocarcinoma patients.