The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Computed tomography morphologic features of pulmonary adenocarcinoma with brain/bone metastasis

  • Hwang, Ki-Eun (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Oh, Su-Jin (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Park, Chul (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Jeon, Se-Jeong (Department of Radiology, Wonkwang University School of Medicine) ;
  • Lee, Jeong-Mi (Department of Public Health, Wonkwang University School of Medicine) ;
  • Cha, Byong-Ki (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School) ;
  • Yoon, Kwon-Ha (Department of Radiology, Wonkwang University School of Medicine) ;
  • Jeong, Eun-Taik (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Kim, Hak-Ryul (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine)
  • Received : 2016.04.21
  • Accepted : 2016.11.07
  • Published : 2018.03.01
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Abstract

Background/Aims: Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. Methods: We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. Results: In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ${\geq}50mm$ (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ${\geq}30%$ (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ${\geq}30%$ (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). Conclusions: We found that necrosis ${\geq}30%$ was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare, Korea Health Industry Development Institute (KHIDI)

References

  1. Langley RR, Fidler IJ. Tumor cell-organ microenvironment interactions in the pathogenesis of cancer metastasis. Endocr Rev 2007;28:297-321. https://doi.org/10.1210/er.2006-0027
  2. Langley RR, Fidler IJ. The seed and soil hypothesis revisited: the role of tumor-stroma interactions in metastasis to different organs. Int J Cancer 2011;128:2527-2535. https://doi.org/10.1002/ijc.26031
  3. Chen LL, Blumm N, Christakis NA, Barabasi AL, Deisboeck TS. Cancer metastasis networks and the prediction of progression patterns. Br J Cancer 2009;101:749-758. https://doi.org/10.1038/sj.bjc.6605214
  4. Kakiuchi S, Daigo Y, Tsunoda T, Yano S, Sone S, Nakamura Y. Genome-wide analysis of organ-preferential metastasis of human small cell lung cancer in mice. Mol Cancer Res 2003;1:485-499.
  5. Bains MS. Surgical treatment of lung cancer. Chest 1991;100:826-837. https://doi.org/10.1378/chest.100.3.826
  6. Perisano C, Spinelli MS, Graci C, et al. Soft tissue metastases in lung cancer: a review of the literature. Eur Rev Med Pharmacol Sci 2012;16:1908-1914.
  7. Port JL, Kent MS, Korst RJ, Libby D, Pasmantier M, Altorki NK. Tumor size predicts survival within stage IA nonsmall cell lung cancer. Chest 2003;124:1828-1833. https://doi.org/10.1378/chest.124.5.1828
  8. Chang MY, Mentzer SJ, Colson YL, et al. Factors predicting poor survival after resection of stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2007;134:850-856. https://doi.org/10.1016/j.jtcvs.2007.03.044
  9. Huang C, Liu D, Masuya D, et al. Clinical application of biological markers for treatments of resectable nonsmall- cell lung cancers. Br J Cancer 2005;92:1231-1239. https://doi.org/10.1038/sj.bjc.6602481
  10. Maitra A, Kumar V. Box on morphology of adenocarcinoma. In: Kumar V, Abbas AK, Fausto N, Mitchell R, eds. Robbins Basic Pathology. 8th ed. Philadelphia: Saunders, 2007:479-540.
  11. Hess KR, Varadhachary GR, Taylor SH, et al. Metastatic patterns in adenocarcinoma. Cancer 2006;106:1624-1633. https://doi.org/10.1002/cncr.21778
  12. Takashima S, Maruyama Y, Hasegawa M, et al. Prognostic significance of high-resolution CT findings in small peripheral adenocarcinoma of the lung: a retrospective study on 64 patients. Lung Cancer 2002;36:289-295. https://doi.org/10.1016/S0169-5002(01)00489-5
  13. Aoki T, Tomoda Y, Watanabe H, et al. Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 2001;220:803-809. https://doi.org/10.1148/radiol.2203001701
  14. Jiang B, Takashima S, Miyake C, et al. Thin-section CT findings in peripheral lung cancer of 3 cm or smaller: are there any characteristic features for predicting tumor histology or do they depend only on tumor size? Acta Radiol 2014;55:302-308. https://doi.org/10.1177/0284185113495834
  15. Asamura H, Suzuki K, Watanabe S, Matsuno Y, Maeshima A, Tsuchiya R. A clinicopathological study of resected subcentimeter lung cancers: a favorable prognosis for ground glass opacity lesions. Ann Thorac Surg 2003;76:1016-1022. https://doi.org/10.1016/S0003-4975(03)00835-X
  16. Tateishi M, Fukuyama Y, Hamatake M, et al. Characteristics of non-small cell lung cancer 3 cm or less in diameter. J Surg Oncol 1995;59:251-254. https://doi.org/10.1002/jso.2930590411
  17. Alexander BM, Othus M, Caglar HB, Allen AM. Tumor volume is a prognostic factor in non-small-cell lung cancer treated with chemoradiotherapy. Int J Radiat Oncol Biol Phys 2011;79:1381-1387. https://doi.org/10.1016/j.ijrobp.2009.12.060
  18. Bajard A, Westeel V, Dubiez A, et al. Multivariate analysis of factors predictive of brain metastases in localised nonsmall cell lung carcinoma. Lung Cancer 2004;45:317-323. https://doi.org/10.1016/j.lungcan.2004.01.025
  19. Inoue M, Takakuwa T, Minami M, et al. Clinicopathologic factors influencing postoperative prognosis in patients with small-sized adenocarcinoma of the lung. J Thorac Cardiovasc Surg 2008;135:830-836. https://doi.org/10.1016/j.jtcvs.2007.10.034
  20. Kilicgun A, Turna A, Sayar A, Solak O, Urer N, Gurses A. Very important histopathological factors in patients with resected non-small cell lung cancer: necrosis and perineural invasion. Thorac Cardiovasc Surg 2010;58:93-97. https://doi.org/10.1055/s-0029-1186240
  21. Park SY, Lee HS, Jang HJ, Lee GK, Chung KY, Zo JI. Tumor necrosis as a prognostic factor for stage IA nonsmall cell lung cancer. Ann Thorac Surg 2011;91:1668-1673. https://doi.org/10.1016/j.athoracsur.2010.12.028
  22. Swinson DE, Jones JL, Richardson D, Cox G, Edwards JG, O’Byrne KJ. Tumour necrosis is an independent prognostic marker in non-small cell lung cancer: correlation with biological variables. Lung Cancer 2002;37:235-240. https://doi.org/10.1016/S0169-5002(02)00172-1
  23. Takahashi Y, Akishima-Fukasawa Y, Kobayashi N, et al. Prognostic value of tumor architecture, tumor-associated vascular characteristics, and expression of angiogenic molecules in pancreatic endocrine tumors. Clin Cancer Res 2007;13:187-196. https://doi.org/10.1158/1078-0432.CCR-06-1408
  24. Gkogkou C, Frangia K, Saif MW, Trigidou R, Syrigos K. Necrosis and apoptotic index as prognostic factors in non-small cell lung carcinoma: a review. Springerplus 2014;3:120. https://doi.org/10.1186/2193-1801-3-120
  25. Dworakowska D, Jassem E, Jassem J, et al. Prognostic value of the apoptotic index analysed jointly with selected cell cycle regulators and proliferation markers in nonsmall cell lung cancer. Lung Cancer 2009;66:127-133. https://doi.org/10.1016/j.lungcan.2009.01.008
  26. Edinger AL, Thompson CB. Death by design: apoptosis, necrosis and autophagy. Curr Opin Cell Biol 2004;16:663-669. https://doi.org/10.1016/j.ceb.2004.09.011
  27. Langendijk H, Thunnissen E, Arends JW, et al. Cell proliferation and apoptosis in stage III inoperable non-small cell lung carcinoma treated by radiotherapy. Radiother Oncol 2000;56:197-207. https://doi.org/10.1016/S0167-8140(00)00218-8
  28. Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev 2008;21:305-333. https://doi.org/10.1128/CMR.00060-07
  29. Watanabe Y, Kusumoto M, Yoshida A, Suzuki K, Asamura H, Tsuta K. Surgically resected solitary cavitary lung adenocarcinoma: association between clinical, pathologic, and radiologic findings and prognosis. Ann Thorac Surg 2015;99:968-974. https://doi.org/10.1016/j.athoracsur.2014.10.040
  30. Onn A, Choe DH, Herbst RS, et al. Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome. Radiology 2005;237:342-347. https://doi.org/10.1148/radiol.2371041650
  31. Sugimoto Y, Semba H, Fujii S, Furukawa E, Kurano R. Clinical analysis of primary lung cancer with a thin-walled cavity to explain the mechanism of thin-walled cavity formation. Nihon Kokyuki Gakkai Zasshi 2007;45:460-464.

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