术前SUVmax在病理IA期肺腺癌中超越基于大小的T分期的增量预后价值
Incremental Prognostic Value of Preoperative SUVmax Beyond Size-Based T Descriptors in Pathologic Stage IA Lung Adenocarcinoma.
作者
作者单位
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. chucky0406@gmail.com.
摘要
中文
本研究旨在确定哪种单一的临床病理或代谢指标能最有效地定义超越基于大小的T描述符的高危亚组。研究回顾性分析了2007年至2021年间接受肺叶切除术并纵隔淋巴结清扫的1198例病理IA期肺腺癌患者。通过比较各变量最佳阈值定义的高危组的5年累积复发率，评估各风险因素的纳入诊断性能。使用净重分类改善指数量化超越T描述符的增量预后价值。中位随访时间为54个月（四分位距[IQR]，35-76个月），总体5年累积复发率为4.4%。在所有测试变量中，SUVmax在高危组中产生最高的5年复发率：SUVmax≥6.0的患者5年累积复发率为25.4%。在多变量Fine-Gray分析中，SUVmax是唯一保留独立预后意义的因素（校正后的亚分布风险比1.058；95%置信区间[CI]，1.022-1.095；P=0.001），也是分类净重分类改善分析中唯一显著改善超越T描述符风险重分类的因素（净重分类改善指数0.346；P=0.008）。在已确立的预后因素中，SUVmax在识别复发风险升高的病理IA期肺腺癌患者方面表现出最一致的纳入性能，提供了超越基于大小T描述符的增量预后价值。SUVmax阈值≥6.0识别出一个5年累积复发率超过25%的亚组，该亚组可能需要加强监测并纳入围手术期全身治疗试验的前瞻性评估。
English
This study aimed to identify which single clinicopathologic or metabolic indicator most effectively defines a high-risk subgroup beyond size-based T descriptors. The study retrospectively analyzed 1198 patients with pathologic stage IA lung adenocarcinoma who underwent lobectomy with mediastinal lymph node dissection between 2007 and 2021. The rule-in performance of each risk factor was assessed by comparing the 5-year cumulative incidence of recurrence in high-risk groups defined by the optimal threshold for each variable. Net reclassification improvement was used to quantify incremental prognostic value beyond T descriptors. The median follow-up period was 54 months (interquartile range [IQR], 35-76 months), and the overall 5-year cumulative incidence of recurrence was 4.4%. Among all the variables tested, SUVmax yielded the highest 5-year recurrence rate in its high-risk group: patients with an SUVmax of 6.0 or higher had a 5-year cumulative recurrence incidence of 25.4%. In the multivariable Fine-Gray analysis, SUVmax was the only variable that retained independent prognostic significance (adjusted subdistribution hazard ratio, 1.058; 95% confidence interval (CI), 1.022-1.095; P = 0.001) and the only factor that significantly improved risk reclassification beyond T descriptors in the categorical net reclassification improvement analysis (net reclassification improvement, 0.346; P = 0.008). Among established prognostic factors, SUVmax demonstrated the most consistent rule-in performance for identifying patients with pathologic stage IA lung adenocarcinoma at elevated recurrence risk, providing incremental prognostic value beyond size-based T descriptors. An SUVmax threshold of ≥ 6.0 identified a subgroup with a 5-year cumulative incidence of recurrence exceeding 25%, who may warrant intensified surveillance and prospective evaluation in perioperative systemic therapy trials.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 3.8
- 新锐分区
- 2区