The accuracy of tumor size measurement and clinical T staging for resected lung cancer: Retrospective analysis of 1 880 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Kai ¹ ,  DENG Chaoqiang ^2,3,4,5 ,  ZHANG Yang ^2,3,4,5

1. Department of Thoracic Surgery, Jiangdu People’s Hospital of Yangzhou City Affilialed Yangzhou University, Yangzhou, 225200, Jiangsu, P. R. China;
2. Department of Thoracic Surgery, Cancer Center, Fudan University, Shanghai, 200032, P. R. China;
3. State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, 200032, P. R. China;
4. Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, P. R. China;
5. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China;

Corresponding author：

DENG Chaoqiang, Email: fdudengcq@163.com; ZHANG Yang, Email: fduzhangyang1987@hotmail.com

Keywords：

Lung cancer; tumor size; staging; treatment strategy

DOI：

10.7507/1007-4848.202310061

Video：

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Objective To elucidate the correlation between radiological tumor size (RTS) and pathological tumor size (PTS), and to evaluate the accuracy of clinical T staging. Methods Data on patients who underwent complete resection between September 2018 and June 2019 were retrospectively collected. The correlation between RTS and PTS was analyzed by and we assessed the agreement between clinical and pathologic T staging. Results Finally, 1 880 patients were included. There were 778 males and 1 102 females at average age of 57±11 years. In the entire cohort, the RTS and PTS was 19.1±13.5 mm and 17.7±14.0 mm, respectively (P<0.001). The RTS and PTS showed a strong linear correlation with the Pearson’s correlation coefficient calculated as 0.897. The mean RTS was significantly larger than PTS (P<0.001) in tumors≤3 cm, but significantly smaller in tumors>4 cm. The overall concordance rate between clinical and pathological T staging was 65.6%. Clinical staging failed to detect T4 disease in 29.4% (5/17) of patients. Male patients and the presence of cavities within nodules were independent significant factors leading to inaccurate clinical T staging. Conclusions The correlation between the tumor sizes measured on thin-section computed tomography and pathologic specimens varies with the real tumor size. Methods and techniques for improving clinical T staging accuracy is in urgent need.

Citation： ZHOU Kai, DENG Chaoqiang, ZHANG Yang. The accuracy of tumor size measurement and clinical T staging for resected lung cancer: Retrospective analysis of 1 880 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 223-228. doi: 10.7507/1007-4848.202310061 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Zheng RS, Zhang SW, Sun KX, et al. Cancer statistics in China, 2016.Zhonghua Zhong Liu Za Zhi, 2023, 45(3): 212-220.
3.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
4.	Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stageⅠa non-small-cell lung cancer. N Engl J Med 2023, 388(6): 489-498.
5.	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.
6.	Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.
7.	Lampen-Sachar K, Zhao B, Zheng J, et al. Correlation between tumor measurement on computed tomography and resected specimen size in lung adenocarcinomas. Lung Cancer, 2012, 75(3): 332-335.
8.	Cetinkaya E, Turna A, Yildiz P, et al. Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma. Eur J Cardiothorac Surg, 2002, 22(6): 1000-1005.
9.	Navani N, Fisher DJ, Tierney JF, et al. The accuracy of clinical staging of stageⅠ-Ⅲa non-small cell lung cancer: An analysis based on individual participant data. Chest, 2019, 155(3): 502-509.
10.	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.
11.	Lim JK, Shin KM, Lee SY, et al. Can emphysema influence size discrepancy between radiologic and pathologic size measurement in subsolid lung adenocarcinomas? Thorac Cancer, 2019, 10(10): 1919-1927.
12.	Yu HM, Liu YF, Hou M, et al. Evaluation of gross tumor size using CT, 18F-FDG PET, integrated 18F-FDG PET/CT and pathological analysis in non-small cell lung cancer. Eur J Radiol, 2009, 72(1): 104-113.
13.	Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol, 2014, 9(1): 74-82.
14.	Cerfolio RJ, Bryant AS, Ojha B, et al. Improving the inaccuracies of clinical staging of patients with NSCLC: A prospective trial. Ann Thorac Surg, 2005, 80(4): 1207S-1213S.
15.	Heineman DJ, Ten Berge MG, Daniels JM, et al. The quality of staging non-small cell lung cancer in the Netherlands: Data from the dutch lung surgery audit. Ann Thorac Surg, 2016, 102(5): 1622-1629.
16.	Kim TH, Kim SJ, Ryu YH, et al. Pleomorphic carcinoma of lung: Comparison of CT features and pathologic findings. Radiology, 2004, 232(2): 554-559.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Zheng RS, Zhang SW, Sun KX, et al. Cancer statistics in China, 2016.Zhonghua Zhong Liu Za Zhi, 2023, 45(3): 212-220.
3. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
4. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stageⅠa non-small-cell lung cancer. N Engl J Med 2023, 388(6): 489-498.
5. 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.
6. Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.
7. Lampen-Sachar K, Zhao B, Zheng J, et al. Correlation between tumor measurement on computed tomography and resected specimen size in lung adenocarcinomas. Lung Cancer, 2012, 75(3): 332-335.
8. Cetinkaya E, Turna A, Yildiz P, et al. Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma. Eur J Cardiothorac Surg, 2002, 22(6): 1000-1005.
9. Navani N, Fisher DJ, Tierney JF, et al. The accuracy of clinical staging of stageⅠ-Ⅲa non-small cell lung cancer: An analysis based on individual participant data. Chest, 2019, 155(3): 502-509.
10. 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.
11. Lim JK, Shin KM, Lee SY, et al. Can emphysema influence size discrepancy between radiologic and pathologic size measurement in subsolid lung adenocarcinomas? Thorac Cancer, 2019, 10(10): 1919-1927.
12. Yu HM, Liu YF, Hou M, et al. Evaluation of gross tumor size using CT, 18F-FDG PET, integrated 18F-FDG PET/CT and pathological analysis in non-small cell lung cancer. Eur J Radiol, 2009, 72(1): 104-113.
13. Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol, 2014, 9(1): 74-82.
14. Cerfolio RJ, Bryant AS, Ojha B, et al. Improving the inaccuracies of clinical staging of patients with NSCLC: A prospective trial. Ann Thorac Surg, 2005, 80(4): 1207S-1213S.
15. Heineman DJ, Ten Berge MG, Daniels JM, et al. The quality of staging non-small cell lung cancer in the Netherlands: Data from the dutch lung surgery audit. Ann Thorac Surg, 2016, 102(5): 1622-1629.
16. Kim TH, Kim SJ, Ryu YH, et al. Pleomorphic carcinoma of lung: Comparison of CT features and pathologic findings. Radiology, 2004, 232(2): 554-559.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The accuracy of tumor size measurement and clinical T staging for resected lung cancer: Retrospective analysis of 1 880 patients

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