Risk factors analysis for pleural invasion in small nodular typeⅠA lung adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Hong ¹ , CHEN Yuan ² ,  WANG Jun ¹ , TANG Jianwei ¹ , YUAN Mei ³ , CHEN Liang ¹

1. Department of Thoracic Surgery, The First Clinical Medical College of Nanjing Medical University, Nanjing, 210000, P.R.China;
2. Department of Clinical Medicine, Nanjing Medical University, Nanjing, 210000, P.R.China;
3. Department of Radiology, The First Clinical Medical College of Nanjing Medical University, Nanjing, 210000, P.R.China;

Corresponding author：

WANG Jun, Email: drwangjun@njmu.edu.cn

Keywords：

Pulmonary nodules; pulmonary adenocarcinoma; pleural invasion

DOI：

10.7507/1007-4848.201902031

Video：

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Objective To explore and analyze the risk factors of pleural invasion in patients with small nodular type stage ⅠA pulmonary adenocarcinoma.Methods From June 2016 to December 2017, 168 patients with small nodular type stage ⅠA pulmonary adenocarcinoma underwent surgical resection in the First Affiliated Hospital of Nanjing Medical University. There were 59 males and 109 females aged 58.7±11.5 years ranging from 28 to 83 years. The clinical data were analyzed retrospectively. Single factor Chi-square test and multivariate logistic regression were used to analyze the independent risk factors of pleural invasion.Results Among 168 patients, 20 (11.9%) were pathologically confirmed with pleural invasion and 148 (88.1%) with no pleural invasion. Single factor analysis revealed significant differences (P<0.05) in nodule size, nodule status, pathological type, relation of lesion to pleura (RLP), distance of lesion to pleura (DLP), epidermal growth factor receptor (EGFR) mutation between patients with and without pleural invasion in stage ⅠA pulmonary adenocarcinoma. Logistic multivariate regression analysis showed that significant differences of nodule size, nodule status, RLP, DLP and EGFR mutation existed between the two groups (P<0.05), which were independent risk factors for pleural invasion.Conclusion Imageological-pathological-biological characteristics of patients with small nodular type stage ⅠA pulmonary adenocarcinoma are closely related to pleural invasion. The possibility of pleural invasion should be evaluated by combining these parameters in clinical diagnosis and treatment.

Citation： LI Hong, CHEN Yuan, WANG Jun, TANG Jianwei, YUAN Mei, CHEN Liang. Risk factors analysis for pleural invasion in small nodular typeⅠA lung adenocarcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(10): 979-983. doi: 10.7507/1007-4848.201902031 Copy

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4.	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.
5.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
6.	Pedersen JH, Saghir Z, Wille MM, et al. Ground-glass opacity lung nodules in the era of lung cancer CT screening: radiology, pathology, and clinical management. Oncology (Williston Park), 2016, 30(3): 266-274.
7.	Travis WD, Brambilla E, Rami-Porta R, et al. Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer. J Thorac Oncol, 2008, 3(12): 1384-1390.
8.	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: executive summary. Proc Am Thorac Soc, 2011, 8(5): 381-385.
9.	Bernstein MB, Krishnan S, Hodge JW, et al. Immunotherapy and stereotactic ablative radiotherapy (ISABR): a curative approach? Nat Rev Clin Oncol, 2016, 13(8): 516-524.
10.	Kodama H, Yamakado K, Hasegawa T, et al. Radiofrequency ablation using a multiple-electrode switching system for lung tumors with 2.0-5.0-cm maximum diameter: phase Ⅱ clinical study. Radiology, 2015, 277(3): 895-902.
11.	Mehta HJ, Ravenel JG, Shaftman SR, et al. The utility of nodule volume in the context of malignancy prediction for small pulmonary nodules. Chest, 2014, 145(3): 464-472.
12.	Boiselle PM, White CS, Ravenel JG. Computed tomographic screening for lung cancer: current practice patterns at leading academic medical centers. JAMA Intern Med, 2014, 174(2): 286-287.
13.	Wang S, Chen A, Yang L, et al. Comprehensive analysis of lung cancer pathology images to discover tumor shape and boundary features that predict survival outcome. Sci Rep, 2018, 8(1): 10393.
14.	Maeyashiki T, Suzuki K, Hattori A, et al. The size of consolidation on thin-section computed tomography is a better predictor of survival than the maximum tumour dimension in resectable lung cancer. Eur J Cardiothorac Surg, 2013, 43(5): 915-918.
15.	Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
16.	Kim H, Goo JM, Suh YJ, et al. Implication of total tumor size on the prognosis of patients with clinical stage ⅠA lung adenocarcinomas appearing as part-solid nodules: Does only the solid portion size matter? Eur Radiol, 2019, 29(3): 1586-1594.
17.	Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2005, 130(1): 160-165.
18.	Bellier J, Perentes JY, Abdelnour-Berchtold E, et al. A plea for thoracoscopic resection of solitary pulmonary nodule in cancer patients. Surg Endosc, 2017, 31(11): 4705-4710.
19.	Gallagher B, Urbanski SJ. The significance of pleural elastica invasion by lung carcinomas. Hum Pathol, 1990, 21(5): 512-517.
20.	Zhao LL, Xie HK, Zhang LP, et al. Visceral pleural invasion in lung adenocarcinoma ≤3 cm with ground-glass opacity: a clinical, pathological and radiological study. J Thorac Dis, 2016, 8(7): 1788-1797.
21.	鲍彤, 肖飞, 郭永庆, 等. 对孤立性肺结节恶性概率预测模型的验证、比较和改良. 中国胸心血管外科临床杂志, 2018, 25(6): 471-476.
22.	Le H, Wang X, Zha Y, et al. Peripheral lung adenocarcinomas harboring epithelial growth factor receptor mutations with microRNA-135b overexpression are more likely to invade visceral pleura. Oncol Lett, 2017, 14(6): 7931-7940.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
2. Paing MP, Choomchuay S. Ground glass opacity (GGO) nodules detection from lung CT scans. Yogyakarta: International Symposium on Electronics and Smart Devices, 2017. 230-235.
3. Kawase A, Yoshida J, Ishii G, et al. Visceral pleural invasion classification in non-small cell lung cancer. J Thorac Oncol, 2010, 5(11): 1784-1788.
4. 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.
5. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
6. Pedersen JH, Saghir Z, Wille MM, et al. Ground-glass opacity lung nodules in the era of lung cancer CT screening: radiology, pathology, and clinical management. Oncology (Williston Park), 2016, 30(3): 266-274.
7. Travis WD, Brambilla E, Rami-Porta R, et al. Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer. J Thorac Oncol, 2008, 3(12): 1384-1390.
8. 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: executive summary. Proc Am Thorac Soc, 2011, 8(5): 381-385.
9. Bernstein MB, Krishnan S, Hodge JW, et al. Immunotherapy and stereotactic ablative radiotherapy (ISABR): a curative approach? Nat Rev Clin Oncol, 2016, 13(8): 516-524.
10. Kodama H, Yamakado K, Hasegawa T, et al. Radiofrequency ablation using a multiple-electrode switching system for lung tumors with 2.0-5.0-cm maximum diameter: phase Ⅱ clinical study. Radiology, 2015, 277(3): 895-902.
11. Mehta HJ, Ravenel JG, Shaftman SR, et al. The utility of nodule volume in the context of malignancy prediction for small pulmonary nodules. Chest, 2014, 145(3): 464-472.
12. Boiselle PM, White CS, Ravenel JG. Computed tomographic screening for lung cancer: current practice patterns at leading academic medical centers. JAMA Intern Med, 2014, 174(2): 286-287.
13. Wang S, Chen A, Yang L, et al. Comprehensive analysis of lung cancer pathology images to discover tumor shape and boundary features that predict survival outcome. Sci Rep, 2018, 8(1): 10393.
14. Maeyashiki T, Suzuki K, Hattori A, et al. The size of consolidation on thin-section computed tomography is a better predictor of survival than the maximum tumour dimension in resectable lung cancer. Eur J Cardiothorac Surg, 2013, 43(5): 915-918.
15. Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
16. Kim H, Goo JM, Suh YJ, et al. Implication of total tumor size on the prognosis of patients with clinical stage ⅠA lung adenocarcinomas appearing as part-solid nodules: Does only the solid portion size matter? Eur Radiol, 2019, 29(3): 1586-1594.
17. Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2005, 130(1): 160-165.
18. Bellier J, Perentes JY, Abdelnour-Berchtold E, et al. A plea for thoracoscopic resection of solitary pulmonary nodule in cancer patients. Surg Endosc, 2017, 31(11): 4705-4710.
19. Gallagher B, Urbanski SJ. The significance of pleural elastica invasion by lung carcinomas. Hum Pathol, 1990, 21(5): 512-517.
20. Zhao LL, Xie HK, Zhang LP, et al. Visceral pleural invasion in lung adenocarcinoma ≤3 cm with ground-glass opacity: a clinical, pathological and radiological study. J Thorac Dis, 2016, 8(7): 1788-1797.
21. 鲍彤, 肖飞, 郭永庆, 等. 对孤立性肺结节恶性概率预测模型的验证、比较和改良. 中国胸心血管外科临床杂志, 2018, 25(6): 471-476.
22. Le H, Wang X, Zha Y, et al. Peripheral lung adenocarcinomas harboring epithelial growth factor receptor mutations with microRNA-135b overexpression are more likely to invade visceral pleura. Oncol Lett, 2017, 14(6): 7931-7940.

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Risk factors analysis for pleural invasion in small nodular typeⅠA lung adenocarcinoma

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