CT衍生腹部器官体积测量预测切除的非小细胞肺癌的无复发生存和无病生存：多中心回顾性队列研究
CT-derived abdominal organ volumetrics for predicting recurrence-free and disease-free survival in resected non-small cell lung cancer: a multicenter retrospective cohort study.
作者
作者单位
- First Clinical College, Hubei University of Chinese Medicine, Wuhan, China.
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
- Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China.
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
摘要
中文
术后复发仍然是非小细胞肺癌（NSCLC）根治性切除后的主要挑战，传统的临床病理因素不能完全捕获复发风险的异质性。尽管CT衍生的身体成分生物标志物已与NSCLC的结局相关联，但腹部实体器官体积测量的预后相关性仍未得到充分表征。我们研究了术前CT衍生的腹部器官体积和体表面积（BSA）标准化器官指数是否与切除NSCLC的复发相关结局相关。这项多中心回顾性队列研究纳入了1,762例在五个中心接受根治性切除术且术前1个月内有CT扫描的临床和病理确诊NSCLC患者。纳入3,263例健康对照队列用于基线器官体积比较。临床和实验室变量从术前记录中提取，实验室检查通常在术前7天内获得。基于深度学习的自动分割流程量化了脾、肝、胰腺、双肾和双侧肾上腺，器官指数以BSA标准化。倾向评分匹配（PSM）仅限于患者-对照器官体积比较。复发根据随访临床和影像记录确定。无复发生存（RFS）和无病生存（DFS）作为复发相关结局进行评估。在完整NSCLC队列中进行多变量Cox模型分析，并调整年龄、性别、T分期、病理类型、糖尿病、高血压、吸烟、饮酒、体重指数（BMI）、白蛋白、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。NSCLC队列中位年龄60岁，934例（53.0%）为女性。在中位随访期RFS 39.7个月和DFS 39.4个月期间，发生198例RFS事件和219例DFS事件。与PSM后的健康对照相比，NSCLC患者显示脾、肝、肾和肾上腺体积增大，胰腺体积减小。在多变量Cox分析中，较低的胰腺体积和胰腺指数与较短的RFS [风险比（HR）=0.735，P<0.001；HR=0.729，P<0.001]和DFS（HR=0.791，P=0.002；HR=0.787，P=0.001）独立相关。较低的左肾上腺指数（LAGI）也与较短的RFS（HR=0.845，P=0.030）和DFS（HR=0.833，P=0.01）相关。较低的肝体积（LVV）指数仅与RFS相关（HR=0.834，P=0.02），而较低的左肾上腺体积（LAGV）仅与DFS相关（HR=0.843，P=0.03）。术前CT衍生的腹部器官体积测量，特别是胰腺和左肾上腺指标，与NSCLC根治性切除后的复发相关结局独立相关。这些影像生物标志物可能为术后复发风险分层提供补充信息。需要进一步的前瞻性验证。
English
Postoperative recurrence remains a major challenge after curative-intent resection for non-small cell lung cancer (NSCLC), and conventional clinicopathologic factors do not fully capture recurrence risk heterogeneity. Although computed tomography (CT)-derived body composition biomarkers have been associated with outcomes in NSCLC, the prognostic relevance of abdominal solid-organ volumetrics remains insufficiently characterized. We investigated whether preoperative CT-derived abdominal organ volumes and body surface area (BSA)-normalized organ indices were associated with recurrence-related outcomes in resected NSCLC. This multicenter retrospective cohort study included 1,762 patients with clinically and pathologically confirmed NSCLC who underwent curative-intent resection at five centers and had preoperative CT within 1 month before surgery. A healthy control cohort of 3,263 individuals was included for baseline organ-volumetric comparison. Clinical and laboratory variables were extracted from preoperative records, with laboratory tests generally obtained within 7 days before surgery. A deep learning-based automated segmentation pipeline quantified the spleen, liver, pancreas, bilateral kidneys, and bilateral adrenal glands, and organ indices were normalized to BSA. Propensity score matching (PSM) was restricted to patient-control organ-volumetric comparisons. Recurrence was ascertained from follow-up clinical and imaging records. Recurrence-free survival (RFS) and disease-free survival (DFS) were evaluated as recurrence-related outcomes. Multivariable Cox models were performed in the full NSCLC cohort and adjusted for age, sex, T stage, pathological types, diabetes, hypertension, smoking, drinking, body mass index (BMI), albumin, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The NSCLC cohort had a median age of 60 years, and 934 patients (53.0%) were women. During median follow-up periods of 39.7 months for RFS and 39.4 months for DFS, 198 RFS events and 219 DFS events occurred. Compared with healthy controls after PSM, patients with NSCLC showed larger spleen, liver, kidney, and adrenal volumes and smaller pancreatic volume. In multivariable Cox analyses, lower pancreatic volume and pancreatic index were independently associated with shorter RFS [hazard ratio (HR) =0.735, P<0.001; HR =0.729, P<0.001, respectively] and DFS (HR =0.791, P=0.002; HR =0.787, P=0.001, respectively). Lower left adrenal gland index (LAGI) was also associated with shorter RFS (HR =0.845, P=0.030) and DFS (HR =0.833, P=0.01). Lower liver volume (LVV) index was associated with RFS only (HR =0.834, P=0.02), whereas lower left adrenal gland volume (LAGV) was associated with DFS only (HR =0.843, P=0.03). Preoperative CT-derived abdominal organ volumetrics, particularly pancreatic and left adrenal gland metrics, were independently associated with recurrence-related outcomes after curative-intent resection of NSCLC. These imaging biomarkers may provide complementary information for postoperative recurrence risk stratification. Further prospective validation is warranted.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q2
- 影响因子
- 3.4
- 新锐分区
- 3区