Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer
Abstract Background Solid nodules (SN) had more aggressive features and a poorer prognosis than part-solid nodules (PSN). This study aimed to evaluate the specific impacts of nodule radiological appearance (SN vs. PSN) on lymph node metastasis and prognosis based on solid size in cT1 non-small cell...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12931-024-02727-z |
| _version_ | 1797273545909207040 |
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| author | Zhihua Li Cheng Pan Wenzheng Xu Chen Zhao Xianglong Pan Zhibo Wang Weibing Wu Liang Chen |
| author_facet | Zhihua Li Cheng Pan Wenzheng Xu Chen Zhao Xianglong Pan Zhibo Wang Weibing Wu Liang Chen |
| author_sort | Zhihua Li |
| collection | DOAJ |
| description | Abstract Background Solid nodules (SN) had more aggressive features and a poorer prognosis than part-solid nodules (PSN). This study aimed to evaluate the specific impacts of nodule radiological appearance (SN vs. PSN) on lymph node metastasis and prognosis based on solid size in cT1 non-small cell lung cancer (NSCLC). Methods Patients with cT1 NSCLC who underwent anatomical resection between 2010 and 2019 were retrospectively screened. Univariable and multivariable logistic regression analyses were adopted to evaluate the associations between nodule radiological appearance and lymph node metastasis. The log-rank test and Cox regression analyses were applied for prognostic evaluation. The cumulative recurrence risk was evaluated by the competing risk model. Results There were 958 and 665 NSCLC patients with PSN and SN. Compared to the PSN group, the SN arm had a higher overall lymph node metastasis rate (21.7% vs. 2.7%, P < 0.001), including nodal metastasis at N1 stations (17.7% vs. 2.1%), N2 stations (14.0% vs. 1.6%), and skip nodal metastasis (3.9% vs. 0.6%). However, for cT1a NSCLC, no significant difference existed between SN and PSN (0 vs. 0.4%, P = 1). In addition, the impacts of nodule radiological appearance on lymph node metastasis varied between nodal stations. Solid NSCLC had an inferior prognosis than part-solid patients (5-year disease-free survival: 79.3% vs. 96.2%, P < 0.001). The survival inferiority only existed for cT1b and cT1c NSCLC, but not for cT1a. Strikingly, even for patients with nodal involvement, SN still had a poorer disease-free survival (P = 0.048) and a higher cumulative incidence of recurrence (P < 0.001) than PSN. Specifically, SN had a higher recurrence risk than PSN at each site. Nevertheless, the distribution of recurrences between SN and PSN was similar, except that N2 lymph node recurrences were more frequent in solid NSCLC (28.21% vs. 7.69%, P = 0.041). Conclusion SN had higher risks of lymph node metastasis and poorer prognosis than PSN for cT1b and cT1c NSCLC, but not for cT1a. SN exhibited a greater proportion of N2 lymph node recurrence than PSN. SN and PSN needed distinct strategies for nodal evaluation and postoperative follow-up. |
| first_indexed | 2024-03-07T14:45:55Z |
| format | Article |
| id | doaj.art-a85160fc48b9437e85433eab202a661c |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-03-07T14:45:55Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-a85160fc48b9437e85433eab202a661c2024-03-05T20:02:13ZengBMCRespiratory Research1465-993X2024-02-0125111310.1186/s12931-024-02727-zDistinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancerZhihua Li0Cheng Pan1Wenzheng Xu2Chen Zhao3Xianglong Pan4Zhibo Wang5Weibing Wu6Liang Chen7Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityDepartment of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityAbstract Background Solid nodules (SN) had more aggressive features and a poorer prognosis than part-solid nodules (PSN). This study aimed to evaluate the specific impacts of nodule radiological appearance (SN vs. PSN) on lymph node metastasis and prognosis based on solid size in cT1 non-small cell lung cancer (NSCLC). Methods Patients with cT1 NSCLC who underwent anatomical resection between 2010 and 2019 were retrospectively screened. Univariable and multivariable logistic regression analyses were adopted to evaluate the associations between nodule radiological appearance and lymph node metastasis. The log-rank test and Cox regression analyses were applied for prognostic evaluation. The cumulative recurrence risk was evaluated by the competing risk model. Results There were 958 and 665 NSCLC patients with PSN and SN. Compared to the PSN group, the SN arm had a higher overall lymph node metastasis rate (21.7% vs. 2.7%, P < 0.001), including nodal metastasis at N1 stations (17.7% vs. 2.1%), N2 stations (14.0% vs. 1.6%), and skip nodal metastasis (3.9% vs. 0.6%). However, for cT1a NSCLC, no significant difference existed between SN and PSN (0 vs. 0.4%, P = 1). In addition, the impacts of nodule radiological appearance on lymph node metastasis varied between nodal stations. Solid NSCLC had an inferior prognosis than part-solid patients (5-year disease-free survival: 79.3% vs. 96.2%, P < 0.001). The survival inferiority only existed for cT1b and cT1c NSCLC, but not for cT1a. Strikingly, even for patients with nodal involvement, SN still had a poorer disease-free survival (P = 0.048) and a higher cumulative incidence of recurrence (P < 0.001) than PSN. Specifically, SN had a higher recurrence risk than PSN at each site. Nevertheless, the distribution of recurrences between SN and PSN was similar, except that N2 lymph node recurrences were more frequent in solid NSCLC (28.21% vs. 7.69%, P = 0.041). Conclusion SN had higher risks of lymph node metastasis and poorer prognosis than PSN for cT1b and cT1c NSCLC, but not for cT1a. SN exhibited a greater proportion of N2 lymph node recurrence than PSN. SN and PSN needed distinct strategies for nodal evaluation and postoperative follow-up.https://doi.org/10.1186/s12931-024-02727-zNon-small cell lung cancerRadiological appearanceLymph node metastasisRecurrence patternsPrognosis |
| spellingShingle | Zhihua Li Cheng Pan Wenzheng Xu Chen Zhao Xianglong Pan Zhibo Wang Weibing Wu Liang Chen Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer Respiratory Research Non-small cell lung cancer Radiological appearance Lymph node metastasis Recurrence patterns Prognosis |
| title | Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer |
| title_full | Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer |
| title_fullStr | Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer |
| title_full_unstemmed | Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer |
| title_short | Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer |
| title_sort | distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical t1 non small cell lung cancer |
| topic | Non-small cell lung cancer Radiological appearance Lymph node metastasis Recurrence patterns Prognosis |
| url | https://doi.org/10.1186/s12931-024-02727-z |
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