Analysis Of The Relationship Between Prognostic Factors And Imaging Features In 169 Cases Peripheral Lung Adenocarcinoma With Visceral Pleural Invasion

Objective:To evaluate the Correlation between the imaging features such as consolidation to tumor ratio( C/T)in high resolusion computed tomographic(CT) and the prognostic factor and survival rate in patients with peripheral lung adenocarcinoma with pleural invasion.Methods:To retrospectively analyze clinical data of 645 patients who underwent surgical resection from 2008 to 2010 at the first affiliated hospital of Dalian Medical university. All the patient have been pathologically confirmed as Peripheral lung adenocarcinoma.Of witch were followed up until December 2014 with once every three months in the first year of postoperative and every six months afterwards. Then choose the patients with pleura invasion and collect its imaging features such as the C/T ritro and so on detected by high resolution CT. Then utilize chi-square test to analyze the relationship between their clinical information and imaging features provided by CT. Kaplan-Meier survival analysis was applied to calculate survival rates and log-rank test was applied to compare the differences between groups.A multivariable proportional hazard model(Cox) was applied toassess the independent prognostic factors.Results: The mean age of 169 peripheral Lung adenocacinoma patients was 62-year old and the median age was 66(35-80),of which male 73 cases(44%), female 96 cases(56%). Numbers of patients with well differentiated, moderately differentiated and poorly differentiated disease were 92(54%),48(28%),and 329(18%),respectively.Pulmonary lobectomy was performed in 140(83%)patients and local resection in 23(14%)patients.The maximum tumor diameter≤2cm 78 cases(46.2%),>2cm 至 3cm,55 cases(32.5%),>3cm-5cm,32cases(18.9%),>5cm-7cm, 4cases(2.4%)。N stage,N0,155 cases(91.7%),N1,14 cases(8.3%). Imaging features: There were 121 cases of C/T ratio>0.7(72%) and 48 cases of C/T ratio≤0.7(28%),70 cases(41%) of lobulation sign and 95 cases(59%) without that, 74(44%) of speculation sign and 95 cases(56%) without glitches sign, 29 cases(17%) with bronchogram sign while 140 cases(83%) without that.Plot receiver operating(ROC) curve using different C / T ratio among patients with benign nodules and malignant nodules and determine the optimal cut-off point(Optimal cut-off point) to define the maximum detection of the diagnose index(sensitivity plus specificity) as the best diagnostic thresholds.As a result,C/T ratio of about 0.7 was one of the best indicator of the differential diagnosis between peripheral lung adenocacinoma with Visceral pleural invasion and benign nodules. The results of chi-square test showed that there were no statistical significance between clinical information and C/T ratio.Univariate analysis suggested that cell differentiation grade and C/T ratio were all significant predictors of survival for peripheral lung adenocacinoma with pleural invasion. The 5-year survival rates of well differentiated、moderately differentiated and poorly differentiated were respectively 63.8%、55.6% and 40.8%,with significant difference(P=0.033).As well, the 5-year survival rates of C/T≤0.7and C/T>0.7 were 82.1% and 27.8%, with significant difference(P=0.004).However,The maximum tumor diameter, N stage,C/T ratio>0.7(HR=4.816,P<0.01) was independent prognostic factor influencing survival in the final multivariate Cox regression of peripheral adenocacinoma with Visceral pleural invasionConclusion: 1. C/T ratio of about 0.7 was one of indicator of the differential diagnosis between peripheral lung cancer with Visceral pleural invasion and benign nodules.2. The prognosis of peripheral lung adenocacinoma with Visceral pleural invasion ad is influenced by C/T ratio>0.7,The maximum tumor diameter, N stage. The maximum tumor diameter, N stage and C/T ratio are all significant predictors of survival rate of patients.