Background Sublobar resection for lung cancer is usually guided by cutoff values for consolidation size (maximal diameter of the solid tumor component) and consolidation-to-tumor ratio (CTR). The effects of these factors as continuous variables and the reason for established cutoffs are, to the knowledge of the authors, unexplored. Purpose To quantitatively assess the predictive value of CTR and consolidation size for cancer recurrence risk after sublobar resection in clinical stage IA lung adenocarcinoma. Materials and Methods This retrospective study reviewed sublobar resection for clinical stage IA lung adenocarcinoma performed between January 2010 and December 2019. A restricted cubic spline function verified linearity by estimating recurrence probabilities using CTR and consolidation size obtained on preoperative CT scans. Statistical analyses included a Cox proportional hazards model to identify risk factors for cancer recurrence and the Cochran-Armitage trend test for the association between CTR and consolidation size. Results Of 1032 enrolled patients (age, 63.9 years ± 9.9 [SD]; 464 male patients), 523 (50.7%) and 509 (49.3%) underwent wedge resection and segmentectomy, respectively. Among patients with a CTR between 1% and 50% (n = 201), 187 (93.0%) had a consolidation size of less than or equal to 10 mm (P < .001). There was a positive association between the risk of recurrence with CTR and consolidation size (r2 = 0.727; P < .001). The recurrence rate showed the greatest increase when CTR was greater than 50% or consolidation size was greater than 10 mm. Specifically, the recurrence rate increased from 2.1% (three of 146) at 26%-50% CTR to 8.3% (nine of 108) at 51%-75% CTR, and from 4.4% (eight of 183) for 6-10-mm consolidation size to 11.9% (23 of 194) for 11-15-mm consolidation size. The probability of recurrence exhibited linearity and increased with CTR and consolidation size. Conclusion Cancer recurrence risk after sublobar resection for stage IA adenocarcinoma consistently rises with CTR and consolidation size. Current guideline cutoffs for sublobar resection remain clinically relevant given observed recurrence rates. © RSNA, 2024 Supplemental material is available for this article.

中文翻译：

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使用术前胸部 CT 扫描预测肺腺癌患者亚肺叶切除术后的复发。


背景肺癌的亚肺叶切除术通常以实变大小（实体瘤成分的最大直径）和实变与肿瘤比 （CTR） 的临界值为指导。据作者所知，这些因素作为连续变量的影响以及建立临界值的原因尚未得到探索。目的 定量评估 CTR 和实变大小对临床 IA 期肺腺癌亚肺叶切除术后癌症复发风险的预测价值。材料和方法 本回顾性研究回顾了 2010 年 1 月至 2019 年 12 月期间进行的临床 IA 期肺腺癌的亚肺叶切除术。受限三次样条函数通过使用术前 CT 扫描获得的 CTR 和实变大小估计复发概率来验证线性。统计分析包括用于确定癌症复发风险因素的 Cox 比例风险模型和用于 CTR 与巩固规模之间关联的 Cochran-Armitage 趋势检验。结果 1032 例入组患者 （年龄 63.9 岁 ± 9.9 [SD];464 例男性患者），分别有 523 例 （50.7%） 和 509 例 （49.3%） 接受了楔形切除术和肺段切除术。在 CTR 在 1% 到 50% 之间 （n = 201） 的患者中，187 例 （93.0%） 的实变大小小于或等于 10 毫米 （P < .001）。CTR 的复发风险与实变大小呈正相关 （r2 = 0.727;P < .001）.当 CTR 大于 50% 或实变大小大于 10 mm 时，复发率增加最大。具体来说，复发率从 26%-50% CTR 的 2.1%（146 人中的 3 人）增加到 51%-75% CTR 的 8.3%（108 人中的 9 人），以及从 6-10 毫米实变大小的 4.4%（183 人中的 8 人）增加到 11 人。9%（194 个中的 23 个）用于 11-15 毫米的巩固尺寸。复发概率呈线性，并随着 CTR 和实变大小的增加而增加。结论 IA 期腺癌亚肺叶切除术后癌症复发风险随 CTR 和实变大小的持续增加而升高。鉴于观察到的复发率，目前亚肺叶切除术的指南临界值仍然具有临床意义。© RSNA，2024 年本文提供补充材料。