Predictive value of radiological features on spread through air spaces in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zhan ¹ , ZHANG Zhenrong ² , FENG Hongxiang ² , SHAO Weipeng ¹ , GU Xinlei ³ , SUN Hongliang ⁴ ,  LIU Deruo ²

1. Department of General Thoracic Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P.R.China;
2. Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, P.R.China;
3. Department of Thoracic Surgery, Peking University International Hospital, Beijing, 102206, P.R.China;
4. Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, P.R.China;

Corresponding author：

LIU Deruo, Email: deruoliu@vip.sina.com

Keywords：

Lung tumor; adenocarcinoma; radiology; ground-glass opacity; spread through air spaces

DOI：

10.7507/1007-4848.202002134

Video：

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Objective To investigate the predictive value of preoperative radiological features on spread through air spaces (STAS) in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity, and to provide a basis for the selection of surgical methods for these patients.Methods The clinical data of 768 patients with stage cⅠA lung adenocarcinoma undergoing operation in our hospital from 2017 to 2018 were reviewed, and 333 early stage lung adenocarcinoma patients with predominant ground-glass opacity were selected. There were 92 males and 241 females, with an average age of 57.0±10.0 years. Statistical analysis was performed using SPSS 22.0.Results STAS-positive patients were mostly invasive adenocarcinoma (P=0.037), and had more micropapillary component (P<0.001) and more epidermal growth factor receptor (EGFR) gene mutations (P=0.020). There were no statistically significant differences between the STAS-positive and STAS-negative patients in other clinicopathological features. Univariate analysis showed that the maximum diameter of tumor in lung window (P=0.029), roundness (P=0.035), maximum diameter of solid tumor component in lung window (P<0.001), consolidation/tumor ratio (CTR, P<0.001), maximum area of the tumor in mediastinum window (P=0.001), tumor disappearance ratio (TDR, P<0.001), average CT value (P=0.001) and lobulation sign (P=0.038) were risk factors for STAS positive. Multivariate logistic regression analysis showed that the CTR was an independent predictor of STAS (OR=1.05, 95%CI 1.02 to 1.07, P<0.001), and the area under the receiver operating characteristic (ROC) curve was 0.71 (95%CI 0.58 to 0.85, P=0.002). When the cutoff value was 19%, the sensitivity of predicting STAS was 66.7%, and the specificity was 75.2%.Conclusion CTR is a good radiological feature to predict the occurrence of STAS in early lung adenocarcinoma with predominant ground-glass opacity. For the stagecⅠA lung adenocarcinoma with predominant ground-glass opacity and CTR ≥19%, the possibility of STAS positive is greater, and sublobar resection needs to be carefully considered.

Citation： LIU Zhan, ZHANG Zhenrong, FENG Hongxiang, SHAO Weipeng, GU Xinlei, SUN Hongliang, LIU Deruo. Predictive value of radiological features on spread through air spaces in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 19-24. doi: 10.7507/1007-4848.202002134 Copy

1.	Kadota K, Nitadori JI, Sima CS, et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage Ⅰ lung adenocarcinomas. J Thorac Oncol, 2015, 10(5): 806-814.
2.	Warth A, Beasley MB, Mino-Kenudson M. Breaking new ground: The evolving concept of spread through air spaces (STAS). J Thorac Oncol, 2017, 12(2): 176-178.
3.	Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
4.	Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stageⅠ lung adenocarcinoma. Interact Cardiovasc Thorac Surg, 2016, 23(4): 567-572.
5.	Uruga H, Fujii T, Fujimori S, et al. Semiquantitative assessment of tumor spread through air spaces (STAS) in early-stage lung adenocarcinomas. J Thorac Oncol, 2017, 12(7): 1046-1051.
6.	Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stageⅠ lung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol, 2019, 43(8): 1033-1041.
7.	Toyokawa G, Yamada Y, Tagawa T, et al. Significance of spread through air spaces in resected pathological stageⅠ lung adenocarcinoma. Ann Thorac Surg, 2018, 105(6): 1655-1663.
8.	Eguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis. J Thorac Oncol, 2019, 14(1): 87-98.
9.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stageⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
10.	Warth A. Spread through air spaces (STAS): A comprehensive update. Transl Lung Cancer Res, 2017, 6(5): 501-507.
11.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
12.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
13.	Shimosato Y, Suzuki A, Hashimoto T, et al. Prognostic implications of fibrotic focus (Scar) in small peripheral lung cancers. Am J Surg Pathol, 1980, 4(4): 365-373.
14.	Collins J, Stern EJ. Ground-glass opacity at CT: The ABCs. AJR Am J Roentgenol, 1997, 169(2): 355-367.
15.	Song SH, Ahn JH, Lee HY, et al. Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma. Eur Radiol, 2016, 26(6): 1538-1546.
16.	Heidinger BH, Anderson KR, Nemec U, et al. Lung adenocarcinoma manifesting as pure ground-glass nodules: Correlating CT size, volume, density, and roundness with histopathologic invasion and size. J Thorac Oncol, 2017, 12(8): 1288-1298.
17.	Toyokawa G, Yamada Y, Tagawa T, et al. Computed tomography features of resected lung adenocarcinomas with spread through air spaces. J Thorac Cardiovasc Surg, 2018, 156(4): 1670-1676.
18.	Koezuka S, Mikami T, Tochigi N, et al. Toward improving prognosis prediction in patients undergoing small lung adenocarcinoma resection: Radiological and pathological assessment of diversity and intratumor heterogeneity. Lung Cancer, 2019, 135: 40-46.
19.	Kim SK, Kim TJ, Chung MJ, et al. Lung adenocarcinoma: CT features associated with spread through air spaces. Radiology, 2018, 289(3): 831-840.

1. Kadota K, Nitadori JI, Sima CS, et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage Ⅰ lung adenocarcinomas. J Thorac Oncol, 2015, 10(5): 806-814.
2. Warth A, Beasley MB, Mino-Kenudson M. Breaking new ground: The evolving concept of spread through air spaces (STAS). J Thorac Oncol, 2017, 12(2): 176-178.
3. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
4. Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stageⅠ lung adenocarcinoma. Interact Cardiovasc Thorac Surg, 2016, 23(4): 567-572.
5. Uruga H, Fujii T, Fujimori S, et al. Semiquantitative assessment of tumor spread through air spaces (STAS) in early-stage lung adenocarcinomas. J Thorac Oncol, 2017, 12(7): 1046-1051.
6. Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stageⅠ lung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol, 2019, 43(8): 1033-1041.
7. Toyokawa G, Yamada Y, Tagawa T, et al. Significance of spread through air spaces in resected pathological stageⅠ lung adenocarcinoma. Ann Thorac Surg, 2018, 105(6): 1655-1663.
8. Eguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis. J Thorac Oncol, 2019, 14(1): 87-98.
9. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stageⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
10. Warth A. Spread through air spaces (STAS): A comprehensive update. Transl Lung Cancer Res, 2017, 6(5): 501-507.
11. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
12. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
13. Shimosato Y, Suzuki A, Hashimoto T, et al. Prognostic implications of fibrotic focus (Scar) in small peripheral lung cancers. Am J Surg Pathol, 1980, 4(4): 365-373.
14. Collins J, Stern EJ. Ground-glass opacity at CT: The ABCs. AJR Am J Roentgenol, 1997, 169(2): 355-367.
15. Song SH, Ahn JH, Lee HY, et al. Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma. Eur Radiol, 2016, 26(6): 1538-1546.
16. Heidinger BH, Anderson KR, Nemec U, et al. Lung adenocarcinoma manifesting as pure ground-glass nodules: Correlating CT size, volume, density, and roundness with histopathologic invasion and size. J Thorac Oncol, 2017, 12(8): 1288-1298.
17. Toyokawa G, Yamada Y, Tagawa T, et al. Computed tomography features of resected lung adenocarcinomas with spread through air spaces. J Thorac Cardiovasc Surg, 2018, 156(4): 1670-1676.
18. Koezuka S, Mikami T, Tochigi N, et al. Toward improving prognosis prediction in patients undergoing small lung adenocarcinoma resection: Radiological and pathological assessment of diversity and intratumor heterogeneity. Lung Cancer, 2019, 135: 40-46.
19. Kim SK, Kim TJ, Chung MJ, et al. Lung adenocarcinoma: CT features associated with spread through air spaces. Radiology, 2018, 289(3): 831-840.

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Predictive value of radiological features on spread through air spaces in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity

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