Development and validation of a nomogram for predicting spread through air spaces in stage ⅠA lung adenocarcinoma

doi:10.19401/j.cnki.1007-3639.2022.12.009

Abstract

Abstract:

Background and purpose: Spread through air spaces (STAS) is a poor prognostic factor for early lung adenocarcinoma, especially in patients with wedge resection. Preoperative prediction of STAS is helpful to select a better surgical treatment. This study aimed to develop and validate a nomogram based on preoperative clinical and computed tomography (CT) characteristics to predict STAS in stage ⅠA lung adenocarcinoma. Methods: A total of 595 patients with stage ⅠA lung adenocarcinoma who underwent surgical treatment in Zhongshan Hospital Fudan University from January 2017 to December 2018 were retrospectively analyzed. The results of STAS were evaluated by paraffin embedded tissues fixed with 4% formaldehyde solution. Based on preoperative clinical data and chest CT, 4 clinical characteristics and 11 CT characteristics were analyzed. The independent predictors of STAS in clinical and CT characteristics were identified by logistic regression analysis and then used to build a nomogram. Concordance index (C-index), area under the curve (AUC) of receiver operating characteristic (ROC) and calibration plots were used to evaluate the performance of the model. Results: Among the 595 stage ⅠA lung adenocarcinoma patients, 87 patients (14.6%) were STAS positive. Univariate and multivariate logistic regression analyses showed that lobulation (OR=8.156, 95% CI: 1.021-65.099), spiculation (OR=5.258, 95% CI: 2.506-11.032) and consolidation tumor ratio (CTR) (0.50<CTR≤0.75; OR=16.955, 95% CI: 3.579-80.309; 0.75<CTR≤1.00; OR=20.793, 95% CI: 4.383-98.636) were independent predictors of STAS positivity. The nomogram based on these predictors achieved good predictive performance for STAS with a C-index of 0.901, an AUC of 0.897 and a well-fitted calibration curve. Conclusion: This study developed and validated a nomogram for predicting STAS in stage ⅠA lung adenocarcinoma. This model is simple to operate and has good predictive performance, which is conducive to the selection of reasonable surgical methods before operation.

Key words: Lung adenocarcinoma, Spread through air space, Nomogram

CLC Number:

R734.2

ZHANG Longfu, LIU Jie, NI Zheng, LU Xinyuan, HU Bin, WANG Hao, FENG Mingxiang, ZHANG Yong. Development and validation of a nomogram for predicting spread through air spaces in stage ⅠA lung adenocarcinoma[J]. China Oncology, 2022, 32(12): 1210-1217.

Figures/Tables 6

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References 21

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Characteristics	Positive (N=87)	Negative (N=508)	P value	Characteristics	Positive (N=87)	Negative (N=508)	P value
Age/year			<0.001	CTR			<0.001
<65	47	340		CTR≤0.50	3	324
≥65	40	168		0.50<CTR≤0.75	12	60
Gender			<0.001	0.75<CTR≤1.00	72	124
Male	50	182		Emphysema			<0.001
Female	37	326		Absent	63	451
Smoke			<0.001	Present	24	57
Ever	44	89		Lobulation			<0.001
Never	43	419		Absent	1	179
CEA			0.002	Present	86	329
Normal	76	488		Spiculation			<0.001
High	11	20		Absent	11	365
Lesion location			0.337	Present	76	143
Upper and middle lobe	54	342		Pleural retraction			0.124
Lower lobe	33	166		Absent	43	296
Nodule pattern			<0.001	Present	44	212
Pure GGN	1	97		Vacuole sign			0.853
Mixed GGN	28	335		Absent	57	338
Solid	58	76		Present	30	170
Tumor sizeD/cm			0.007	Vascular change			0.095
D≤1	5	83		Normal	8	82
1<D≤2	49	296		Convergent	79	426
1<D≤3	33	129		Nodule-pleural types			0.160
				No connection	57	292
				Attachment	30	216

Variable	OR	95% CI	P value	Variable	OR	95% CI	P value
Age/year				CTR
<65	1.000	-	-	CTR≤0.50	1.000	-	-
≥65	1.722	1.086-2.729	0.021	0.50<CTR≤0.75	21.599	5.917-78.845	<0.001
Gender				0.75<CTR≤1.00	62.709	19.398-202.721	<0.001
Female	1.000	-	-	Emphysema
Male	2.420	1.524-3.842	<0.001	Absent	1.000	-	-
Smoke				Present	3.014	1.747-5.197	<0.001
Never	1.000	-	-	Lobulation
Ever	4.817	2.985-7.773	<0.001	Absent	1.000	-	-
CEA				Present	46.790	6.462-338.792	<0.001
Normal	1.000	-	-	Spiculation
High	3.531	1.627-7.661	0.001	Absent	1.000	-	-
Lesion location				Present	17.635	9.103-34.160	<0.001
Lower lobe	1.000	-	-	Pleural retraction
Upper and middle lobe	0.794	0.495-1.272	0.338	Absent	1.000	-	-
Nodule pattern				Present	1.428	0.905-2.253	0.125
Pure GGN	1.000	-	-	Vacuole sign
Mixed GGN	8.107	1.089-60.352	0.041	Absent	1.000	-	-
Solid	74.026	10.023-546.687	<0.001	Present	1.046	0.648-1.689	0.853
Tumor sizeD/cm				Vascular change
D≤1	1.000	-	-	Normal	1.000	-	-
1<D≤2	2.740	1.061-7.118	0.037	Convergent	1.900	0.884-4.083	0.100
2<D≤3	4.246	1.593-11.316	0.004	Nodule-pleural types
				No connection	1.000	-	-
				Attachment	0.711	0.442-1.145	0.161

Variable	OR	95% CI	P value
Age/year
<65	1.000	—	—
≥65	1.095	0.606-1.977	0.763
Gender
Female	1.000	—	—
Male	0.631	0.221-1.8	0.390
Smoke
Never	1.000	—	—
Ever	2.460	0.870-6.949	0.089
CEA
Normal	1.000	—	—
High	1.916	0.693-5.296	0.210
Nodule pattern
Pure GGN	1.000	—	—
Mixed GGN	0.285	0.022-3.568	0.330
Solid	0.679	0.041-8.108	0.685
Tumor sizeD/cm
D≤1	1.000	—	—
1<D≤2	1.004	0.311- 3.238	0.994
2<D≤3	0.923	0.274- 3.104	0.897
CTR
CTR≤0.50	1.000	—	—
0.50<CTR≤0.75	16.955	3.579- 80.309	<0.001
0.75<CTR≤1.00	20.793	4.383-98.636	<0.001
Emphysema
Absent	1.000	—	—
Present	0.851	0.384- 1.882	0.691
Lobulation
Absent	1.000	—	—
Present	8.156	1.021-65.099	0.048
Spiculation
Absent	1.000	—	—
Present	5.258	2.506-11.032	<0.001