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Clinical T1aN0M0 lung cancer: differences in clinicopathological patterns and oncological outcomes based on the findings on high-resolution computed tomography

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Abstract

Objectives

To elucidate the clinicopathological characteristics and oncological outcomes of clinical T1aN0M0 (c-T1N0M0) lung cancer based on the newest 8th TNM classification.

Methods

A total of 257 patients with c-T1aN0M0 lung cancer were retrospectively included in this study. According to the solid component size manifesting on the high-resolution computed tomography (HRCT), all lesions were classified as the pure ground-glass nodule (pure-GGN) with a diameter > 3 cm (n = 19), part-solid (n = 174), and pure-solid (n = 64) groups. We evaluated the prognostic impact of clinicopathologic variables including radiological presentations by establishing Cox proportional hazards model.

Results

When we evaluated the prognostic impact based on the radiological subtypes, the 5-year recurrence-free survival (RFS) and overall survival (OS) were significantly different among pure-GGN, part-solid, and pure-solid groups (RFS: 100% versus 95.4% versus 76.6%, p < 0.0001; OS: 100% versus 98.9% versus 87.5%, p < 0.0001). Cox regression analysis revealed the preoperative carcinoembryonic antigen (CEA) level and consolidation tumor ratio (CTR) were independently significant prognosticators related to RFS and OS. Furthermore, a receiver operating characteristic (ROC) verified the CTR (area under ROC [AUC] 0.784, 95%CI 0.697–0.869) was equipped with good performance to predict the postoperative recurrence with a cutoff point at 0.5. Lung cancer with higher CTR tended to be associated with lower survival in the c-T1aN0M0 stage.

Conclusions

For the c-T1aN0M0 lung cancer, pulmonary nodules manifested as the pure-GGN and part-solid subtypes had an excellent prognosis and may be considered as the “early-stage” cancer, whereas those with pure-solid appearance were associated with the high risk of recurrence despite the sub-centimeter size.

Key Points

• Radiological subtypes could further stratify the risk of lung cancer in cT1a.

• Sub-solid nodule has a favorable survival in c-T1a lung cancer, whereas pure-solid nodule is not always “early-stage” lung cancer and is relatively prone to postoperative recurrence despite the sub-centimeter size.

• The preoperative CEA level and CTR are valuable prognosticators to predict the recurrence in c-T1a lung cancer.

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Abbreviations

AIS:

Adenocarcinoma in situ

ANOVA:

One-way analysis of variance

AUC:

Under the curve for the receiver operating characteristic

CEA:

Carcinoembryonic antigen

c-N0:

Clinical node-negative

CT:

Computed tomography

c-T1a:

Clinical T1a

CTR:

Consolidation tumor ratio

GGN:

Ground-glass nodule

GGO:

Ground-glass opacity

HRCT:

High-resolution CT

HU:

Hounsfield unit

IASLC/ATS/ERS:

The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory International Multidisciplinary Classification

LPA:

Lepidic-predominant adenocarcinoma

LVI:

Lymphatic/vascular invasion

OS:

Overall survival

PET:

Positron emission tomography

RFS:

Recurrence-free survival

ROC:

The receiver operating characteristic curve

SD:

Standard deviation

TNM:

Tumor, node, and metastasis

VPI:

Visceral pleural invasion

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Fei Zhou and Wei Li contributed equally to this study as co-corresponding authors.

  2. Ke Sun and Aijun You contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China

    Ke Sun, Bin Wang & Wei Li

  2. Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China

    Aijun You

  3. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China

    Nan Song & Ziwei Wan

  4. Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China

    Fengying Wu, Wencheng Zhao & Fei Zhou

Authors
  1. Ke Sun
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  2. Aijun You
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  3. Bin Wang
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  4. Nan Song
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  8. Fei Zhou
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  9. Wei Li
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Corresponding authors

Correspondence to Fei Zhou or Wei Li.

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Guarantor

The scientific guarantor of this publication is Wei Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Aijun You kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study/diagnostic or prognostic study/observational

• performed at one institution

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Sun, K., You, A., Wang, B. et al. Clinical T1aN0M0 lung cancer: differences in clinicopathological patterns and oncological outcomes based on the findings on high-resolution computed tomography. Eur Radiol 31, 7353–7362 (2021). https://doi.org/10.1007/s00330-021-07865-2

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