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Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma

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Abstract

Objectives

Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-glass-opacity (GGO) portion on CT have different prognostic significance. Therefore, current T descriptor, defined as the whole tumour diameter without discrimination between solid and GGO, is insufficient. We aimed to determine the prognostic significance of solid tumour size and attempt to include prognostic factors such as tumour disappearance rate (TDR) on CT and SUVmax on PET/CT.

Methods

Five hundred and ninety-five patients with completely resected lung adenocarcinoma were analyzed. We developed a nomogram using whole tumour size, TDR, and SUVmax. External validation was performed in another 102 patients.

Results

In patients with tumours measuring ≤2 cm and >2 to 3 cm, disease free survival (DFS) was significantly associated with solid tumour size (P < 0.001), but not with whole tumour size (P = 0.052). Developed nomogram was significantly superior to the conventional T stage (area under the curve of survival ROC; P = 0.013 by net reclassification improvement) in stratification of patient survival. In the external validation group, significant difference was noted in DFS according to proposed T stage (P = 0.009).

Conclusions

Nomogram-based T descriptors provide better prediction of survival and assessment of individual risks than conventional T descriptors.

Key points

• Current measurement of whole tumour diameter including ground-glass opacity is insufficient

• TDR enables differentiation between invasive solid portion and non-invasive GGO portion

• SUVmax demonstrates the biological aggressiveness of the tumour

• We developed a nomogram using whole tumour size, TDR, and SUVmax

• Nomogram-based clinical T descriptors provide better prediction of survival

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Abbreviations

AIS:

Adenocarcinoma in situ

DFS:

Disease-free survival

FDG:

Fluorodeoxyglucose

GGO:

Ground-glass opacity

MIA:

Minimally invasive adenocarcinoma

NRI:

Net reclassification improvement

OS:

Overall survival

TDR:

Tumour disappearance rate

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Acknowledgments

The scientific guarantor of this publication is Ho Yun Lee. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Author notes

    Authors and Affiliations

    1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea

      So Hee Song, Ho Yun Lee, Eun Young Kim & Kyung Soo Lee

    2. Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea

      Joong Hyun Ahn

    3. Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

      Geewon Lee

    4. Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

      Joon Young Choi

    5. Department of Pathology, Inchun St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Inchun, Korea

      Jun Kang

    6. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

      Joungho Han

    7. Division of Respiratory and Critical Medicine of the Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

      O. Jung Kwon

    8. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

      Hong Kwan Kim, Yong Soo Choi, Jhingook Kim & Young Mog Shim

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    Correspondence to Ho Yun Lee or Geewon Lee.

    Additional information

    So Hee Song and Joong Hyun Ahn contributed equally to this work.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary Figure 1

    Flow chart of participant enrolment. (GIF 11 kb)

    High Resolution Image (TIFF 1233 kb)

    Supplementary Figure 2

    Waterfall plot demonstrates distribution of T status in the training group and external validation group. (GIF 27 kb)

    High Resolution Image (TIFF 875 kb)

    Supplementary Figure 3

    Three lung adenocarcinomas of different size and internal composition. (a) 2.2 cm sized entirely solid lung adenocarcinoma. (b) 2.2 cm sized part-solid lung adenocarcinoma with 1 cm of solid portion. (c) 1 cm sized entirely solid lung adenocarcinoma. (GIF 575 kb)

    High Resolution Image (TIFF 4391 kb)

    Supplementary Table 1

    (DOCX 16 kb)

    Supplementary Table 2

    (DOCX 18 kb)

    Supplementary Table 3

    (DOCX 25 kb)

    Supplementary Table 4

    (DOCX 16 kb)

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    Song, S.H., Ahn, J.H., Lee, H.Y. 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 26, 1538–1546 (2016). https://doi.org/10.1007/s00330-015-4029-0

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    • DOI: https://doi.org/10.1007/s00330-015-4029-0

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