Prognostic significance of location index in resected T1-sized early-stage non-small cell lung cancer. (March 2023)

• Record Type: Journal Article
• Authors: Kang, Seung Wan; Jeong, Won Gi; Lee, Jong Eun; Oh, In-Jae; Song, Sang Yun; Lee, Byung Chan; Kim, Yun-Hyeon
• Is Part Of: Acta radiologica. Volume 64:Number 3(2023)
• Page Start: 1028
• Page End: 1037
• Publication Date: 2023-03
• Subjects: Early-stage non-small cell lung cancer -- central lung cancer -- location index -- prognosis; Radiology, Medical -- Periodicals; Radiography, Medical -- Periodicals; Radiotherapy -- Periodicals; 616.0757
• DOI: 10.1177/02841851221111678
• Languages: English
• ISSNs: 0284-1851

Abstract

Background: While the central location is a known adverse prognostic factor in lung cancer, a precise definition of central lung cancer has not yet emerged. Purpose: To determine the prognostic significance of central lung cancer (defined by location index) in resected T1-sized early-stage non-small cell lung cancer (NSCLC). Material and Methods: Patients with resected T1-sized early-stage NSCLC between 2010 and 2015 at a single tertiary cancer center were retrospectively reviewed. Central lung cancer was defined by a location index of the second tertile or less. Kaplan–Meier analysis with log-rank test and multivariable Cox regression analysis were performed to analyze the relationship between central lung cancer and the prognosis of relapse-free survival (RFS) and overall survival (OS). Inter-observer agreement was assessed using Cohen's kappa value and intraclass correlation coefficient (ICC). Results: Overall, 289 patients (169 men; median age 65 years; interquartile range 58–70 years) were evaluated. Central lung cancer (defined by location index) was adversely associated with RFS ( P = 0.005) and OS ( P = 0.01). Multivariable Cox regression analysis showed that central lung cancer was independently associated with poor RFS (adjusted hazard ratio 1.91; 95% confidence interval [CI] 1.12–3.24; P = 0.017) and OS (adjusted hazard ratio 1.69; 95% CI 1.04–2.74; P = 0.033). Location index demonstrated excellent inter-observer agreement (Cohen's kappa value 0.88; 95% CI 0.82–0.93) with a high ICC (0.98; 95% CI 0.97–0.98). Conclusion: Central lung cancer defined by a location index of the second tertile or lower is an independent adverse prognostic factor in resected T1-sized early-stage NSCLC.