Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement

Hyungjin Kim, Jin Mo Goo, Young Tae Kim, Chang Min Park

Research output: Contribution to journalArticle

Abstract

Objectives: Our study aimed at evaluating the prognostic implications of lung and mediastinal CT display window settings for solid portion measurements on the eighth-edition lung cancer staging system’s clinical T (cT) categorization. Methods: We retrospectively analyzed 691 surgically treated patients from 2009 to 2015 for clinical stage IA lung adenocarcinomas. Solid portions were measured at the lung and mediastinal window settings, respectively, and cT categories were determined for each measurement (cTlung and cTmediastinum). The prognostic power of the two cT factors for disease-free survival (DFS) was assessed using Cox regression, and concordance indices (C-indices) were compared using the Student t test. Subsequently, the patients were split into training and validation cohorts to calculate optimal cutoffs for the cT categorization of mediastinal window–based solid portions (cToptimal) and validate its prognostic performance. Results: Both cTlung ((cT1b: adjusted HR, 3.547; p = 0.017), (cT1c: adjusted HR, 9.439; p < 0.001)) and cTmediastinum ((cT1b: adjusted HR, 4.635; p < 0.001), (cT1c: adjusted HR, 11.235; p < 0.001)) were significantly associated with DFS for each multivariable Cox model. The C-indices were 0.772 (95% CI, 0.702–0.842) for cTlung and 0.787 (95% CI, 0.726–0.848) for cTmediastinum (p = 0.789). The optimal cutoffs for cT categorization of the mediastinal window–based solid portions were 0.9 cm and 1.8 cm. However, there were no significant differences in the C-indices among cTlung, cTmediastinum, and cToptimal (p > 0.05). Conclusions: The prognostic performances of the cT categorizations at the lung and mediastinal windows were not significantly different. The current cT categorization based on the lung window measurement is appropriate as it stands. Key Points: • Discriminatory power of the eighth-edition clinical T category was not significantly affected by the CT display window settings. • Given the facts that the lung window setting enables more sensitive detection of the solid portions and higher correlation with the pathological invasive components, our findings may support adherence to the usage of the lung window setting for the solid portion measurement per the current recommendations.

Original languageEnglish
Pages (from-to)6069-6079
Number of pages11
JournalEuropean Radiology
Volume29
Issue number11
DOIs
StatePublished - 1 Nov 2019

Fingerprint

Lung
Neoplasm Staging
Disease-Free Survival
Adenocarcinoma of lung
Lung Neoplasms
Students

Keywords

  • Adenocarcinoma
  • Disease-free survival
  • Multidetector computed tomography
  • Neoplasm staging
  • Non–small cell lung carcinoma

Cite this

@article{0f33998a25984753ad8756c5403bb5f6,
title = "Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement",
abstract = "Objectives: Our study aimed at evaluating the prognostic implications of lung and mediastinal CT display window settings for solid portion measurements on the eighth-edition lung cancer staging system’s clinical T (cT) categorization. Methods: We retrospectively analyzed 691 surgically treated patients from 2009 to 2015 for clinical stage IA lung adenocarcinomas. Solid portions were measured at the lung and mediastinal window settings, respectively, and cT categories were determined for each measurement (cTlung and cTmediastinum). The prognostic power of the two cT factors for disease-free survival (DFS) was assessed using Cox regression, and concordance indices (C-indices) were compared using the Student t test. Subsequently, the patients were split into training and validation cohorts to calculate optimal cutoffs for the cT categorization of mediastinal window–based solid portions (cToptimal) and validate its prognostic performance. Results: Both cTlung ((cT1b: adjusted HR, 3.547; p = 0.017), (cT1c: adjusted HR, 9.439; p < 0.001)) and cTmediastinum ((cT1b: adjusted HR, 4.635; p < 0.001), (cT1c: adjusted HR, 11.235; p < 0.001)) were significantly associated with DFS for each multivariable Cox model. The C-indices were 0.772 (95{\%} CI, 0.702–0.842) for cTlung and 0.787 (95{\%} CI, 0.726–0.848) for cTmediastinum (p = 0.789). The optimal cutoffs for cT categorization of the mediastinal window–based solid portions were 0.9 cm and 1.8 cm. However, there were no significant differences in the C-indices among cTlung, cTmediastinum, and cToptimal (p > 0.05). Conclusions: The prognostic performances of the cT categorizations at the lung and mediastinal windows were not significantly different. The current cT categorization based on the lung window measurement is appropriate as it stands. Key Points: • Discriminatory power of the eighth-edition clinical T category was not significantly affected by the CT display window settings. • Given the facts that the lung window setting enables more sensitive detection of the solid portions and higher correlation with the pathological invasive components, our findings may support adherence to the usage of the lung window setting for the solid portion measurement per the current recommendations.",
keywords = "Adenocarcinoma, Disease-free survival, Multidetector computed tomography, Neoplasm staging, Non–small cell lung carcinoma",
author = "Hyungjin Kim and Goo, {Jin Mo} and Kim, {Young Tae} and Park, {Chang Min}",
year = "2019",
month = "11",
day = "1",
doi = "10.1007/s00330-019-06216-6",
language = "English",
volume = "29",
pages = "6069--6079",
journal = "European radiology",
issn = "0938-7994",
publisher = "Springer Verlag",
number = "11",

}

Clinical T categorization in stage IA lung adenocarcinomas : prognostic implications of CT display window settings for solid portion measurement. / Kim, Hyungjin; Goo, Jin Mo; Kim, Young Tae; Park, Chang Min.

In: European Radiology, Vol. 29, No. 11, 01.11.2019, p. 6069-6079.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical T categorization in stage IA lung adenocarcinomas

T2 - prognostic implications of CT display window settings for solid portion measurement

AU - Kim, Hyungjin

AU - Goo, Jin Mo

AU - Kim, Young Tae

AU - Park, Chang Min

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objectives: Our study aimed at evaluating the prognostic implications of lung and mediastinal CT display window settings for solid portion measurements on the eighth-edition lung cancer staging system’s clinical T (cT) categorization. Methods: We retrospectively analyzed 691 surgically treated patients from 2009 to 2015 for clinical stage IA lung adenocarcinomas. Solid portions were measured at the lung and mediastinal window settings, respectively, and cT categories were determined for each measurement (cTlung and cTmediastinum). The prognostic power of the two cT factors for disease-free survival (DFS) was assessed using Cox regression, and concordance indices (C-indices) were compared using the Student t test. Subsequently, the patients were split into training and validation cohorts to calculate optimal cutoffs for the cT categorization of mediastinal window–based solid portions (cToptimal) and validate its prognostic performance. Results: Both cTlung ((cT1b: adjusted HR, 3.547; p = 0.017), (cT1c: adjusted HR, 9.439; p < 0.001)) and cTmediastinum ((cT1b: adjusted HR, 4.635; p < 0.001), (cT1c: adjusted HR, 11.235; p < 0.001)) were significantly associated with DFS for each multivariable Cox model. The C-indices were 0.772 (95% CI, 0.702–0.842) for cTlung and 0.787 (95% CI, 0.726–0.848) for cTmediastinum (p = 0.789). The optimal cutoffs for cT categorization of the mediastinal window–based solid portions were 0.9 cm and 1.8 cm. However, there were no significant differences in the C-indices among cTlung, cTmediastinum, and cToptimal (p > 0.05). Conclusions: The prognostic performances of the cT categorizations at the lung and mediastinal windows were not significantly different. The current cT categorization based on the lung window measurement is appropriate as it stands. Key Points: • Discriminatory power of the eighth-edition clinical T category was not significantly affected by the CT display window settings. • Given the facts that the lung window setting enables more sensitive detection of the solid portions and higher correlation with the pathological invasive components, our findings may support adherence to the usage of the lung window setting for the solid portion measurement per the current recommendations.

AB - Objectives: Our study aimed at evaluating the prognostic implications of lung and mediastinal CT display window settings for solid portion measurements on the eighth-edition lung cancer staging system’s clinical T (cT) categorization. Methods: We retrospectively analyzed 691 surgically treated patients from 2009 to 2015 for clinical stage IA lung adenocarcinomas. Solid portions were measured at the lung and mediastinal window settings, respectively, and cT categories were determined for each measurement (cTlung and cTmediastinum). The prognostic power of the two cT factors for disease-free survival (DFS) was assessed using Cox regression, and concordance indices (C-indices) were compared using the Student t test. Subsequently, the patients were split into training and validation cohorts to calculate optimal cutoffs for the cT categorization of mediastinal window–based solid portions (cToptimal) and validate its prognostic performance. Results: Both cTlung ((cT1b: adjusted HR, 3.547; p = 0.017), (cT1c: adjusted HR, 9.439; p < 0.001)) and cTmediastinum ((cT1b: adjusted HR, 4.635; p < 0.001), (cT1c: adjusted HR, 11.235; p < 0.001)) were significantly associated with DFS for each multivariable Cox model. The C-indices were 0.772 (95% CI, 0.702–0.842) for cTlung and 0.787 (95% CI, 0.726–0.848) for cTmediastinum (p = 0.789). The optimal cutoffs for cT categorization of the mediastinal window–based solid portions were 0.9 cm and 1.8 cm. However, there were no significant differences in the C-indices among cTlung, cTmediastinum, and cToptimal (p > 0.05). Conclusions: The prognostic performances of the cT categorizations at the lung and mediastinal windows were not significantly different. The current cT categorization based on the lung window measurement is appropriate as it stands. Key Points: • Discriminatory power of the eighth-edition clinical T category was not significantly affected by the CT display window settings. • Given the facts that the lung window setting enables more sensitive detection of the solid portions and higher correlation with the pathological invasive components, our findings may support adherence to the usage of the lung window setting for the solid portion measurement per the current recommendations.

KW - Adenocarcinoma

KW - Disease-free survival

KW - Multidetector computed tomography

KW - Neoplasm staging

KW - Non–small cell lung carcinoma

UR - http://www.scopus.com/inward/record.url?scp=85064807968&partnerID=8YFLogxK

U2 - 10.1007/s00330-019-06216-6

DO - 10.1007/s00330-019-06216-6

M3 - Article

AN - SCOPUS:85064807968

VL - 29

SP - 6069

EP - 6079

JO - European radiology

JF - European radiology

SN - 0938-7994

IS - 11

ER -