Association between Mortality and Lung Low Attenuation Areas in NSCLC Treated by Surgery.

BACKGROUND: to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC). METHODS: patients who underwent radical surgery for NSCLC at our institution between 1 January 2017 and 30 November 2021 were retrospectively evaluated. Patients who performed staging or follow-up CTs in other institutions, who received lung radiotherapy or chemotherapy, and who underwent previous lung surgery were excluded. At staging and 12-months follow-up CT, LAAs defined as voxels <-950 Hounsfield units, were extracted by software. The percent of LAAs relative to whole-lung volume (%LAAs) and the ratio between LAAs in the lobe to resect and whole-lung LAAs (%LAAs lobe ratio) were calculated. Cox proportional hazards regression analysis was used to test the association between OS and LAAs. RESULTS: the final sample included 75 patients (median age 70 years, IQR 63-75 years; females 29/75, 39%). It identified a significant association with OS for pathological stage III (HR, 6.50; 95%CI, 1.11-37.92; p = 0.038), staging CT %LAAs ≥ 5% (HR, 7.27; 95%CI, 1.60-32.96; p = 0.010), and staging CT %LAA lobe ratio > 10% (HR, 0.24; 95%CI 0.05-0.94; p = 0.046). CONCLUSIONS: in patients with NSCLC who underwent radical surgery, a %LAAs ≥ 5% and a %LAA lobe ratio > 10% at staging CT are predictors, respectively, of shorter and longer OS. The LAA ratio to the whole lung at staging CT could be a critical factor to predict the overall survival of the NSCLC patients treated by surgery.

Software-Based Assessment of Well-Aerated Lung at CT for Quantification of Predicted Pulmonary Function in Resected NSCLC.

Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC who underwent lobectomy or segmentectomy without a history of thoracic radiotherapy or chemotherapy treatment with the availability of PFTs at 12 months follow-up. Postoperative predictive (ppo) lung function was calculated using the resected lobe WAL (the lung volume between −950 and −750 HU) at sCT. The Spearman correlation coefficient (rho) and intraclass correlation coefficient (ICC) were used to the test the agreement between WAL ppo-PFTs and mpo-PFTs. Results: the study included 40 patients (68 years-old, IQR 62−74 years-old; 26/40, 65% males). The WAL ppo-forced expiratory volume in 1 s (FEV1) and the ppo-diffusing capacity of the lung for carbon monoxide (%DLCO) were significantly correlated with corresponding mpo-PFTs (rho = 0.842 and 0.717 respectively; p < 0.001). The agreement with the corresponding mpo-PFTs of WAL ppo-FEV1 was excellent (ICC 0.904), while it was good (ICC 0.770) for WAL ppo-%DLCO. Conclusions: WAL ppo-FEV1 and WAL ppo-%DLCO at sCT showed, respectively, excellent and good agreement with corresponding mpo-PFTs measured 12 months after surgery for NSCLC. WAL is an easy parameter obtained by staging CT that can be used to estimate post-resection lung function for patients with borderline pulmonary function undergoing lung surgery.

Role of visceral pleural invasion and tumor sizing at CT of resected NSCLC in clinical-radiological and pathological T agreement.

OBJECTIVE: To describe in non-small cell lung cancer (NSCLC) the impact of visceral pleural invasion (VPI) and of tumor sizing assessed at computed tomography (CT) on the agreement between clinical-radiological and pathological T staging and its prognostic value. METHODS: Patients affected by NSCLC treated by surgery in the period from January 2017 to September 2020 were retrospectively evaluated. Exclusion criteria were: (1) baseline CT not performed in our hospital; (2) failure of software segmentation at CT of the primary lesion. Clinical-radiological T (cT) was assessed at baseline CT, evaluating in particular T size by semi-automatic tool and VPI (cVPI) visually. Pathological T (pT) and VPI (pVPI) were recorded by pathological report and obtained after formalin-fixation and eventual elastic stain on surgical specimen. The agreement between cT and pT was evaluated by calculating the weighted kappa by Cohen (κw); the association between progression free survival (PFS) with both cT and pT was assessed by the Cox regression analysis. RESULTS: The study included 84 NSCLC in 82 patients (median age 71 years, IQR 63-76 years; females 22/82, 27%). The agreement between cT and pT was poor (κw 0.302, 95%CI 0.158-0.447). The main causes of disagreement were CT oversizing (21%) and false positive cVPI (29%). A significant association was found between PFS and pT2-T3 (HR 2.75, 95%CI 1.21-6.25, p=0.015) but not with cT2-T3 (not retained in the model). CONCLUSIONS: False positive cVPI and oversizing at CT are causes of disagreement between cT and pT in around one-third of resected NSCLC. PFS was significantly associated with pT but not with cT.