Prognostic Value of Computed Tomography Morphologic Characteristics in Stage I Non–Small-cell Lung Cancer

Inja Neralic Meniga; Mirjana Kujundzic Tiljak; Davor Ivankovic; Ivan Aleric; Mirta Zekan; Pero Hrabac; Ivica Mazuranic; Igor Puljic

Disclosures

Clin Lung Cancer. 2010;11(2):98-104. 

In This Article

Abstract and Introduction

Abstract

Background: In this study, we describe the prognostic value of NSCLC morphologic characteristics obtainable by computed tomography (CT) in the preoperative staging. Starting with the initial hypothesis that CT morphologic characteristics of NSCLC have a prognostic value, we conducted a retrospective study that included 194 patients.
Patients and Methods: All patients underwent surgery because of stage IA or IB non–small-cell lung carcinoma (NSCLC). Surgical procedures were performed in our clinic over the period of 9 years and 8 months starting in June 1996 and ending in February 2006. Preoperative CT scans and clinical data available for each patient were analyzed retrospectively.
Results: Over the study period, 93 patients died. The mean survival time was 78.6 months (95% confidence interval was 72.63–84.57 months). After a 2-year follow-up, 85.57% of patients were alive, but this decreased to 63.9% living patients after 5 years. Morphologic tumor characteristics were obtained by analyzing CT images available for each patient. These CT morphologic characteristics were divided into 5 categories: size, tumor edges, structure, and periphery of the tumor, as well as its relation to visceral pleura. We correlated each of these characteristics to the survival of patients.
Conclusion: We conclude that, within stage I NSCLC, patient survival and disease prognosis vary significantly depending on such morphologic characteristics. This fact is one of the weakest points of the current tumor-node-metastasis (TNM) classification. Along with already-established tumor prognostic attributes such as size and TNM grade, we identified CT morphologic characteristics as powerful additional prognostic factors for NSCLC.

Introduction

Lung carcinoma is one of the most lethal tumors among humans. Despite many significant advances in diagnostics, surgical methods, and chemotherapy, survival of patients as well as prognosis in the early stage of the disease has not changed much over the past two decades.[1,2] Overall 5-year survival of patients with non–small-cell lung cancer (NSCLC) in stages IA and IB is around 65%. This means that more than one third of patients undergoing surgery in the early stages of the disease have either local recidives of the disease or extrathoracic metastases.[3]

In this early preoperative stage, prognostic factors play a key role in evaluating survival chances for each patient. The accurate identification of prognostic factors pointing to unfavorable disease prognosis is thus potentially of great importance. The possibility to "filter" patients with bad prognosis within the same stage of the disease could lead to modification of routine therapeutic protocols and to individual approaches to each patient.

Prognostic factors for NSCLC are by no means scarce: more than 160 are described in the literature. However, only a small number of those have been proven to be statistically significant.[4,5] There are two significant groups of NSCLC prognostic factors: patient related and tumor related. Whereas the first group consists of clinical, physical, hematologic, biochemical, and factors related to surgical procedures, the latter describes biologic, pathohistologic, anatomic, and serologic factors.[6]

In this context, the present tumor-node-metastasis (TNM) classification from the year 1997 is the internationally accepted system in which every parameter describes different stages in disease spread. On the other hand, morphologic carcinoma characteristics that are easily assessed by computerized tomography (CT) are poorly explored as potential prognostic factors.

In this study, we describe the prognostic value of the NSCLC morphologic characteristics obtainable by CT in the preoperative staging. Starting with the initial hypothesis that CT morphologic characteristics of NSCLC have a prognostic value, we conducted a retrospective study that included 194 patients.

processing....