A predictive model of lymph node metastasis after thoracoscopic surgery for lung adenocarcinoma with a diameter≤3 cm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Yanhui , LI Ji , WANG Yi , LI Xiaoliang , LUO Lei , CHENG Xin ,  XIE Xiaoyang

Department of Thoracic Surgery, The First People's Hospital of Neijiang, Neijiang Affiliated Hospital of Chongqing Medical University, Neijiang, 641000, Sichuan, P. R. China;

Corresponding author：

XIE Xiaoyang, Email: 13990559066@163.com

Keywords：

Nomogram; lung adenocarcinoma; lymph node metastasis

DOI：

10.7507/1007-4848.202203031

Video：

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Objective To predict the probability of lymph node metastasis after thoracoscopic surgery in patients with lung adenocarcinoma based on nomogram. Methods We analyzed the clinical data of the patients with lung adenocarcinoma treated in the department of thoracic surgery of our hospital from June 2018 to May 2021. The patients were randomly divided into a training group and a validation group. The variables that may affect the lymph node metastasis of lung adenocarcinoma were screened out by univariate logistic regression, and then the clinical prediction model was constructed by multivariate logistic regression. The nomogram was used to show the model visually, the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve to evaluate the calibration degree and practicability of the model. Results Finally 249 patients were collected, including 117 males aged 53.15±13.95 years and 132 females aged 47.36±13.10 years. There were 180 patients in the training group, and 69 patients in the validation group. There was a significant correlation between the 6 clinicopathological characteristics and lymph node metastasis of lung adenocarcinoma in the univariate logistic regression. The area under the ROC curve in the training group was 0.863, suggesting the ability to distinguish lymph node metastasis, which was confirmed in the validation group (area under the ROC curve was 0.847). The nomogram and clinical decision curve also performed well in the follow-up analysis, which proved its potential clinical value. Conclusion This study provides a nomogram combined with clinicopathological characteristics, which can be used to predict the risk of lymph node metastasis in patients with lung adenocarcinoma with a diameter≤3 cm.

Citation： YANG Yanhui, LI Ji, WANG Yi, LI Xiaoliang, LUO Lei, CHENG Xin, XIE Xiaoyang. A predictive model of lymph node metastasis after thoracoscopic surgery for lung adenocarcinoma with a diameter≤3 cm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 71-77. doi: 10.7507/1007-4848.202203031 Copy

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2.	Meng D, Zhou Z, Wang Y, et al. Lymphadenectomy for clinical early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2016, 50(4): 597-604.
3.	Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
4.	Lin W, Huang M, Zhang Z, et al. A retrospective study of the relationship between the pathologic subtype and lymph node metastasis of lung adenocarcinomas of ≤3 cm diameter. Medicine (Baltimore), 2020, 99(36): e21453.
5.	Yu Y, Jian H, Shen L, et al. Lymph node involvement influenced by lung adenocarcinoma subtypes in tumor size ≤3 cm disease: A study of 2268 cases. Eur J Surg Oncol, 2016, 42(11): 1714-1719.
6.	Seok Y, Yang HC, Kim TJ, et al. Frequency of lymph node metastasis according to the size of tumors in resected pulmonary adenocarcinoma with a size of 30 mm or smaller. J Thorac Oncol, 2014, 9(6): 818-824.
7.	Chen C, Chen Z, Cao H, et al. A retrospective clinicopathological study of lung adenocarcinoma: Total tumor size can predict subtypes and lymph node involvement. Clin Imaging, 2018, 47: 52-56.
8.	Ma K, Zhan C, Wang S, et al. Spread through air spaces (STAS): A new pathologic morphology in lung cancer. Clin Lung Cancer, 2019, 20(2): e158-e162.
9.	Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stage Ⅰ Lung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol, 2019, 43(8): 1033-1041.
10.	Han YB, Kim H, Mino-Kenudson M, et al. Tumor spread through air spaces (STAS): Prognostic significance of grading in non-small cell lung cancer. Mod Pathol, 2021, 34(3): 549-561.
11.	Yang L, Yang Y, Ma P, et al. Spread through air spaces predicts a worse survival in patients with stage Ⅰ adenocarcinomas >2 cm after radical lobectomy. J Thorac Dis, 2018, 10(9): 5308-5317.
12.	Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage Ⅰ lung adenocarcinoma. Interact Cardiovasc Thorac Surg, 2016, 23(4): 567-572.
13.	Wen S, Zhou W, Li CM, et al. Ki-67 as a prognostic marker in early-stage non-small cell lung cancer in Asian patients: A meta-analysis of published studies involving 32 studies. BMC Cancer, 2015, 15: 520.
14.	Ahn HK, Jung M, Ha SY, et al. Clinical significance of Ki-67 and p53 expression in curatively resected non-small cell lung cancer. Tumour Biol, 2014, 35(6): 5735-5740.
15.	Zhu WY, Hu XF, Fang KX, et al. Prognostic value of mutant p53, Ki-67, and TTF-1 and their correlation with EGFR mutation in patients with non-small cell lung cancer. Histol Histopathol, 2019, 34(11): 1269-1278.
16.	Yan J, Wang H, Zhou H, et al. Correlation between expression of Ki-67 and MSCT signs in different types of lung adenocarcinoma. Medicine (Baltimore), 2020, 99(2): e18678.
17.	Grant L, Banerji S, Murphy L, et al. Androgen receptor and Ki67 expression and survival outcomes in non-small cell lung cancer. Horm Cancer, 2018, 9(4): 288-294.
18.	Wang XP, Li XH, Zhang L, et al. High level of serum apolipoprotein A-I is a favorable prognostic factor for overall survival in esophageal squamous cell carcinoma. BMC Cancer, 2016, 16: 516.
19.	Lv Y, Miao LY, Chen QF, et al. Monitoring of high-density lipoprotein cholesterol level is predictive of EGFR mutation and efficacy of EGFR-TKI in patients with advanced lung adenocarcinoma. Onco Targets Ther, 2016, 9: 461-468.
20.	Haruki T, Wakahara M, Matsuoka Y, et al. Clinicopathological characteristics of lung adenocarcinoma with unexpected lymph node metastasis. Ann Thorac Cardiovasc Surg, 2017, 23(4): 181-187.
21.	Hung JJ, Yeh YC, Jeng WJ, et al. Predictive value of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma in tumor recurrence and patient survival. J Clin Oncol, 2014, 32(22): 2357-2364.
22.	Hung JJ, Jeng WJ, Chou TY, et al. Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification on death and recurrence in completely resected stage Ⅰ lung adenocarcinoma. Ann Surg, 2013, 258(6): 1079-1086.
23.	Pani E, Kennedy G, Zheng X, et al. Factors associated with nodal metastasis in 2-centimeter or less non-small cell lung cancer. J Thorac Cardiovasc Surg, 2020, 159(3): 1088-1096.

1. Moon Y, Kim KS, Lee KY, et al. Clinicopathologic factors associated with occult lymph node metastasis in patients with clinically diagnosed N0 lung adenocarcinoma. Ann Thorac Surg, 2016, 101(5): 1928-1935.
2. Meng D, Zhou Z, Wang Y, et al. Lymphadenectomy for clinical early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2016, 50(4): 597-604.
3. Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
4. Lin W, Huang M, Zhang Z, et al. A retrospective study of the relationship between the pathologic subtype and lymph node metastasis of lung adenocarcinomas of ≤3 cm diameter. Medicine (Baltimore), 2020, 99(36): e21453.
5. Yu Y, Jian H, Shen L, et al. Lymph node involvement influenced by lung adenocarcinoma subtypes in tumor size ≤3 cm disease: A study of 2268 cases. Eur J Surg Oncol, 2016, 42(11): 1714-1719.
6. Seok Y, Yang HC, Kim TJ, et al. Frequency of lymph node metastasis according to the size of tumors in resected pulmonary adenocarcinoma with a size of 30 mm or smaller. J Thorac Oncol, 2014, 9(6): 818-824.
7. Chen C, Chen Z, Cao H, et al. A retrospective clinicopathological study of lung adenocarcinoma: Total tumor size can predict subtypes and lymph node involvement. Clin Imaging, 2018, 47: 52-56.
8. Ma K, Zhan C, Wang S, et al. Spread through air spaces (STAS): A new pathologic morphology in lung cancer. Clin Lung Cancer, 2019, 20(2): e158-e162.
9. Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stage Ⅰ Lung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol, 2019, 43(8): 1033-1041.
10. Han YB, Kim H, Mino-Kenudson M, et al. Tumor spread through air spaces (STAS): Prognostic significance of grading in non-small cell lung cancer. Mod Pathol, 2021, 34(3): 549-561.
11. Yang L, Yang Y, Ma P, et al. Spread through air spaces predicts a worse survival in patients with stage Ⅰ adenocarcinomas >2 cm after radical lobectomy. J Thorac Dis, 2018, 10(9): 5308-5317.
12. Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage Ⅰ lung adenocarcinoma. Interact Cardiovasc Thorac Surg, 2016, 23(4): 567-572.
13. Wen S, Zhou W, Li CM, et al. Ki-67 as a prognostic marker in early-stage non-small cell lung cancer in Asian patients: A meta-analysis of published studies involving 32 studies. BMC Cancer, 2015, 15: 520.
14. Ahn HK, Jung M, Ha SY, et al. Clinical significance of Ki-67 and p53 expression in curatively resected non-small cell lung cancer. Tumour Biol, 2014, 35(6): 5735-5740.
15. Zhu WY, Hu XF, Fang KX, et al. Prognostic value of mutant p53, Ki-67, and TTF-1 and their correlation with EGFR mutation in patients with non-small cell lung cancer. Histol Histopathol, 2019, 34(11): 1269-1278.
16. Yan J, Wang H, Zhou H, et al. Correlation between expression of Ki-67 and MSCT signs in different types of lung adenocarcinoma. Medicine (Baltimore), 2020, 99(2): e18678.
17. Grant L, Banerji S, Murphy L, et al. Androgen receptor and Ki67 expression and survival outcomes in non-small cell lung cancer. Horm Cancer, 2018, 9(4): 288-294.
18. Wang XP, Li XH, Zhang L, et al. High level of serum apolipoprotein A-I is a favorable prognostic factor for overall survival in esophageal squamous cell carcinoma. BMC Cancer, 2016, 16: 516.
19. Lv Y, Miao LY, Chen QF, et al. Monitoring of high-density lipoprotein cholesterol level is predictive of EGFR mutation and efficacy of EGFR-TKI in patients with advanced lung adenocarcinoma. Onco Targets Ther, 2016, 9: 461-468.
20. Haruki T, Wakahara M, Matsuoka Y, et al. Clinicopathological characteristics of lung adenocarcinoma with unexpected lymph node metastasis. Ann Thorac Cardiovasc Surg, 2017, 23(4): 181-187.
21. Hung JJ, Yeh YC, Jeng WJ, et al. Predictive value of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma in tumor recurrence and patient survival. J Clin Oncol, 2014, 32(22): 2357-2364.
22. Hung JJ, Jeng WJ, Chou TY, et al. Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification on death and recurrence in completely resected stage Ⅰ lung adenocarcinoma. Ann Surg, 2013, 258(6): 1079-1086.
23. Pani E, Kennedy G, Zheng X, et al. Factors associated with nodal metastasis in 2-centimeter or less non-small cell lung cancer. J Thorac Cardiovasc Surg, 2020, 159(3): 1088-1096.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A predictive model of lymph node metastasis after thoracoscopic surgery for lung adenocarcinoma with a diameter≤3 cm

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