Korean Journal of Radiology

  • 제22권4호
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  • Pages.652-662
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  • 2021
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Primary Invasive Mucinous Adenocarcinoma of the Lung: Prognostic Value of CT Imaging Features Combined with Clinical Factors

  • Tingting Wang (Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Yang Yang (Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Xinyue Liu (Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Jiajun Deng (Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Junqi Wu (Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Likun Hou (Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Chunyan Wu (Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Yunlang She (Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Xiwen Sun (Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Dong Xie (Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine) ;
  • Chang Chen (Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine)
  • 투고 : 2020.04.13
  • 심사 : 2020.07.02
  • 발행 : 2021.04.01
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초록

Objective: To investigate the association between CT imaging features and survival outcomes in patients with primary invasive mucinous adenocarcinoma (IMA). Materials and Methods: Preoperative CT image findings were consecutively evaluated in 317 patients with resected IMA from January 2011 to December 2015. The association between CT features and long-term survival were assessed by univariate analysis. The independent prognostic factors were identified by the multivariate Cox regression analyses. The survival comparison of IMA patients was investigated using the Kaplan-Meier method and propensity scores. Furthermore, the prognostic impact of CT features was assessed based on different imaging subtypes, and the results were adjusted using the Bonferroni method. Results: The median follow-up time was 52.8 months; the 5-year disease-free survival (DFS) and overall survival rates of resected IMAs were 68.5% and 77.6%, respectively. The univariate analyses of all IMA patients demonstrated that 15 CT imaging features, in addition to the clinicopathologic characteristics, significantly correlated with the recurrence or death of IMA patients. The multivariable analysis revealed that five of them, including imaging subtype (p = 0.002), spiculation (p < 0.001), tumor density (p = 0.008), air bronchogram (p < 0.001), emphysema (p < 0.001), and location (p = 0.029) were independent prognostic factors. The subgroup analysis demonstrated that pneumonic-type IMA had a significantly worse prognosis than solitary-type IMA. Moreover, for solitary-type IMAs, the most independent CT imaging biomarkers were air bronchogram and emphysema with an adjusted p value less than 0.05; for pneumonic-type IMA, the tumors with mixed consolidation and ground-glass opacity were associated with a longer DFS (adjusted p = 0.012). Conclusion: CT imaging features characteristic of IMA may provide prognostic information and individual risk assessment in addition to the recognized clinical predictors.

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과제정보

The authors wish to thank the biostatistician, Prof. Zhang Aihong (Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China), for the design and guidance of statistical analysis in this study.

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