| Objective To identify CT imaging features that have independent predictive value for IASLC new histological grading system in patients with pathological stage I lung adenocarcinoma,and to explore their similarities and differences in different genders and nodule types.Materials and Methods We retrospectively analyzed the clinical,imaging and pathological data of 379 patients with pathological stage I lung adenocarcinoma who underwent radical resection in our hospital from January 2014 to June 2017.Pathological sections were reviewed and histologic grade was recorded according to the three-stage grading system for invasive lung adenocarcinoma proposed by IASLC in 2020.Multivariate ordered logistic regression analysis was used to identify independent predictors of histological grading system,and ROC curves were used to evaluate their predictive performance.Stratified analyses were also performed within the various subgroups according to sex and nodule type,and the similarities and differences of independent predictors for histological grade in different subgroups were observed.Results Whole tumor size(OR=1.744,95%CI:1.225～2.479,P=0.002),CT value(OR=3.766,95%CI:1.768～8.020,P=0.001)and CTR(OR=2.145,95%CI:1.534～2.995,P<0.001)were independent predictors of histological grading system.Whole tumor size,CT value,and CTR alone were used to predict histologic grade 1 vs.grade 2/3 and grade 1/2 vs.grade 3 with AUC values of 0.633 and 0.673,0.921 and 0.879,0.884 and 0.878,respectively,and cutoff values of 12mm and 17mm,-420HU and-205HU,25%and 75%,respectively.The results of subgroups analysis showed that in the female subgroup,whole tumor size(OR=1.61,95%CI:1.02～2.53,P=0.040),CT value(OR=4.24,95%CI:1.57～11.44,P=0.004)and CTR(OR=2.03,95%CI:1.30～3.18,P=0.002)were independent predictors of histological grade.In the male subgroup,whole tumor size(OR=2.37,95%CI:1.27～4.43,P=0.007),CT value(OR=6.30,95%CI:1.61～24.71,P=0.008),CTR(OR=1.84,95%CI:1.05～3.23,P=0.034),pleural traction(OR=5.41,95%CI:1.85～15.84,P=0.002)and never smoking(OR=0.34,95%CI:0.12～0.96,P=0.041)were independent predictors of histological grade.For non-solid nodules,whole tumor size(OR=2.39,95%CI:1.06～5.38,P=0.036)and CT value(OR=1.012,95%CI:1.004～1.020,P=0.003)were independent predictors of histological grade.For part-solid nodules,CT value(OR=1.007,95%CI:1.002～1.012,P=0.007)and SD value(OR=1.011,95%CI:1.001～1.021,P=0.036)were independent predictors of histological grade.For solid nodules,only whole tumor size(OR=2.89,95%CI:1.12～7.46,P=0.028)was the independent predictor of histological grade.Conclusions Whole tumor size,mean CT value,and CTR were independent predictors of IASLC new histological grading system in patients with pathological stage I lung adenocarcinoma.CT imaging features with independent predictive value for histological grade were varied between different sexes and different nodule types.Objective To identify independent prognostic risk factors for pathological stage I lung adenocarcinoma and construct nomogram models.To explore the heterogeneity of prognostic factors between different sexes and different nodule types.Materials and Methods 379 patients diagnosed with pathological stage I lung adenocarcinoma,who underwent radical resection in our hospital from January 2014 to June 2017,were enrolled and followed up.The disease-free survival curves were drawn by Kaplan-Meier method to verify the prognostic stratification of clinical T stage,IASLC new histological grading system and associated CT features.Twice multivariate Cox regression analyses were performed based on "preoperative+postoperative(i.e.,histologic grade)" and "preoperative only" independent predictors,then prognostic nomogram model 1 and model 2 were constructed.The predictive performance of the two models was evaluated by time-dependent C-index,calibration curve,and clinical decision curve.In addition,we performed subgroup evaluation by stratifying analyses based on gender and nodule type to explore the differences of prognostic risk factors in different subgroups.Result The median follow-up was 70.4 months,and a total of 60 patients relapsed during follow-up.Whole tumor size(cutoff of 17 mm),CT value(cutoff of-205HU)and CTR(cutoff of 25%and 75%)could effectively stratify patient prognosis.The predictors in model 1 included:age(HR:1.05,95%CI:1.02～1.09,P--0.003),burrs sign(HR:5.96,95%CI:2.30～15.43,P<0.001),clinical T stage(HR:2.32,95%CI:1.53～3.52,P<0.001)and histological grade(HR:4.31,95%CI:2.28～8.14,P<0.001).The predictors in model 2 included:age(HR:1.04,95%CI:1.01～1.08,P=0.015),burrs sign(HR:4.55,95%CI:1.73～11.95,P=0.002),clinical T stage(HR:2.49,95%CI:1.58～3.93,P<0.001),whole tumor size(HR:2.81,95%CI:1.16～6.77,P=0.022)and CTR(HR:2.49,95%CI:1.19～5.25,P=0.016).Model 1 and Model 2 have similar prognostic discrimination,with the time-dependent C index of Model 1 stable at about 0.9 and Model 2 close to 0.9.The results based on gender stratification showed that in the female subgroup,tumor size(HR:3.97,95%CI:1.02～15.41,P=0.046),CTR(HR:3.38,95%CI:1.17～9.75,P=0.024),and burrs sign(HR:4.81,95%CI:1.33～17.42,P=0.017)were independent preoperative predictors of DFS.In the male subgroup,clinical T stage(HR:3.80,95%CI:2.49～5.79,P<0.001)and burrs sign(HR:5.57,95%CI:1.26～24.61,P=0.024)were independent preoperative predictors of DFS.The results stratified based on nodule types showed that in part-solid nodule subgroups,whole tumor size(HR:1.14,95%CI:1.07～1.22,P<0.001),CTR(HR:2.40,95%CI:1.32～4.37,P=0.004)and burrs sign(HR:4.95,95%CI:1.27～19.34,P=0.021)were independent preoperative predictors of DFS.In pure solid nodule subgroup,clinical T stage(HR:3.27,95%CI:2.09～5.12,P<0.001)and age(HR:1.09,95%CI:1.04～1.13,P<0.001)were independent preoperative predictors of DFS.Conclusions The preoperative prediction model constructed by integrating clinical T stage and the traditional CT imaging features(whole tumor size and CTR)associated with the IASLC new histological grading system has similar prediction performance for DFS,compared with the postoperative prediction model which added histological grading system into it.In part-solid nodule subgroup and female subgroup,whole tumor size and CTR were independent preoperative predictors of DFS.In the solid nodule subgroup,clinical T stage and age were independent preoperative predictors of DFS. |
