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    Home > Active Ingredient News > Antitumor Therapy > Radiology: A new definition of central lung cancer?

    Radiology: A new definition of central lung cancer?

    • Last Update: 2021-07-30
    • Source: Internet
    • Author: User
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    Lung cancer is the leading cause of cancer-related deaths worldwide , accounting for a quarter of all cancer deaths, and the 5-year survival rate for patients with stage I lung cancer is only 57%
    .
    Therefore, it is important to determine the best treatment plan before surgery and perform accurate staging including assessment of lymph node status .
    The National Comprehensive Cancer Network Guidelines recommends the use of invasive diagnostic tests to determine lymph node metastasis in patients with local progression and central lung cancer (CLC) located in the lungs of two-thirds .
    There is evidence that CLC is associated with mediastinal lymph node metastasis and occult N2 lesions .
    Although CLC can predict mediastinal lymph node metastasis, its prognostic value is not clear .
    This is probably due to the
    inconsistent definition of CLC and insufficient analysis methods by clinicians at this stage .
    In this context, recent studies made on the reaction of mediastinal lymph node lesions CLC defined: The hilar concentric lines defined and according axial CT image concentric lines defined




    One third of the lungs
    .

    Lung cancer is the leading cause of cancer-related deaths worldwide , accounting for a quarter of all cancer deaths, and the 5-year survival rate for patients with stage I lung cancer is only 57%
    .
    Therefore, it is important to determine the best treatment plan before surgery and perform accurate staging including assessment of lymph node status .
    The National Comprehensive Cancer Network Guidelines recommends the use of invasive diagnostic diagnostic tests to determine lymph node metastasis in patients with local progression and central lung cancer (CLC) located in the lungs of two-thirds .
    There is evidence that CLC is associated with mediastinal lymph node metastasis and occult N2 lesions .
    Although CLC can predict mediastinal lymph node metastasis, its prognostic value is not clear .
    This is probably due to the
    inconsistent definition of CLC and insufficient analysis methods by clinicians at this stage .
    In this context, recent studies made on the reaction of mediastinal lymph node lesions CLC definition: The hilar concentric lines defined and according axial CT image concentric lines




    Define the inner third of the lungs
    .

    Recently, a study published in the journal Radiology validated the prognostic value of the two recently proposed CLC definitions by using a method designed to make up for the lack of existing evidence, and studied the effect of quantitative definition of CLC on the prognosis of chest CT .
    More accurate clinical assessment of lung cancer staging and lymph node status provides a new reference basis

    .

    Recently, a study published in the journal Radiology validated the prognostic value of the two recently proposed CLC definitions by using a method designed to make up for the lack of existing evidence, and studied the effect of quantitative definition of CLC on the prognosis of chest CT .
    More accurate clinical assessment of lung cancer staging and lymph node status provides a new reference basis

    .

    This study retrospectively evaluated the clinical and imaging data of patients with lung adenocarcinoma stage T1a-bN0M0 who underwent surgical resection in a tertiary care center from 2009 to 2015
    .
    The primary endpoint is disease-free survival

    .
    Multivariate Cox regression was used to analyze the relationship between the definition of multiple tumor center locations and survival

    .
    For each definition, the time-dependent differentiation measures and the consistency evaluation between readers are carried out

    .

    A total of 436 patients (median age 62 years [interquartile range 55-69 years]; 245 women) were evaluated in this study
    .
    In CT, the tumor in the 1/3 of the hilar ( determined by the concentric lines ) and the survival rate was negatively correlated (CLC 34 cases of patients, 5 cases, 402 cases of lung cancer patients with peripheral 27 cases; the corrected risk The ratio was 2.
    90 [95% CI: 1.
    06, 7.
    96; P = .
    04]) and showed moderate inter-reader agreement (Cohen κ = 0.
    52 [95% CI: 0.
    37, 0.
    68])

    .
    Quantitative determination of the two-thirds position in the lung is also an independent prognostic factor (16 out of 130 CLC patients and 16 out of 306 patients with peripheral lung cancer; the adjusted hazard ratio was 2.
    77 [95% CI: 1.
    36, 5.
    65], P = .
    005), with high agreement among readers (Cohen κ = 0.
    86 [95% CI: 0.
    80, 0.
    91]; P <.
    001)

    .
    The definition based on quantification has higher time- dependent sensitivity (48.
    2% [14.
    27/29.
    61; 95% CI: 28.
    8, 67.
    6] vs 15.
    1% [4.
    47/29.
    61; 95% CI: 1.
    3, 28.
    9]; P <.
    001)

    .

    In CT, the tumor is located in the hilar 1/3 ( determined by the concentric lines ) and the survival rate was negatively correlated quantitatively determining the position of two-thirds of the lungs is also located an independent prognostic factor higher based on a quantitative definition Time- dependent sensitivity

    Figure 1 This figure shows two definitions of central lung cancer: the concentric line from the hilum (yellow line, definition 1) and the concentric line from the midline (solid red line, definition 2) within one-third of the tumor Both are defined as central lung cancer
    .
    The dashed line represents the inner two-thirds boundary (not analyzed), and the blue line is the sagittal line generated by the midline (not analyzed)

    .
    A, Coronal CT image of the bifurcation of the trachea

    .
    B, the horizontal axis CT image of the sternum stem

    .
    Since the yellow line comes from the hilum, it is not displayed

    .
    C, CT scan of hilar horizontal axis

    .
    The red line is the same as the yellow line

    .
    D, Axial CT image above the diaphragm

    .
    Since the yellow line comes from the hilum, it is not displayed

    .

    Figure 1 This figure shows two definitions of central lung cancer: the concentric line from the hilum (yellow line, definition 1) and the concentric line from the midline (solid red line, definition 2) within one-third of the tumor Both are defined as central lung cancer
    .
    The dashed line represents the inner two-thirds boundary (not analyzed), and the blue line is the sagittal line generated by the midline (not analyzed)

    .
    A, Coronal CT image of the bifurcation of the trachea

    .
    B, the horizontal axis CT image of the sternum stem

    .
    Since the yellow line comes from the hilum, it is not displayed

    .
    C, CT scan of hilar horizontal axis

    .
    The red line is the same as the yellow line

    .
    D, Axial CT image above the diaphragm

    .
    Since the yellow line comes from the hilum, it is not displayed

    .

    Figure 2 Axial positioning index of chest CT
    .
    (a) Define the intersection of the horizontal midline of the thoracic cavity (green line) and the mediastinum as the center point of each axial CT image

    .
    Then draw a line between the center point and the center of the tumor and measure the distance (red line)

    .
    The line extends to the adjacent pleura, and the distance from the center point to the pleura is measured (yellow line)

    .
    In this CT image, the positioning index (that is, the ratio of the two measured distances) is 44.
    4%

    .
    (b) The enhanced CT image showed a subsolid nodule in the upper lobe of the right lung.
    The patient was 61 years old and relapsed 426 days after surgery.
    The localization index was 24.
    5%

    .
    (c) CT plain scan image shows a lobulated solid nodule in the right lower lobe, a 57-year-old male

    .
    The localization index was 62%, and the tumor recurred 565 days after surgery

    .

    Figure 2 Axial positioning index of chest CT
    .
    (a) Define the intersection of the horizontal midline of the thoracic cavity (green line) and the mediastinum as the center point of each axial CT image

    .
    Then draw a line between the center point and the center of the tumor and measure the distance (red line)

    .
    The line extends to the adjacent pleura, and the distance from the center point to the pleura is measured (yellow line)

    .
    In this CT image, the positioning index (that is, the ratio of the two measured distances) is 44.
    4%

    .
    (b) The enhanced CT image showed a subsolid nodule in the upper lobe of the right lung.
    The patient was 61 years old and relapsed 426 days after surgery.
    The localization index was 24.
    5%

    .
    (c) CT plain scan image shows a lobulated solid nodule in the right lower lobe, a 57-year-old male

    .
    The localization index was 62%, and the tumor recurred 565 days after surgery

    .

    Figure 3 Kaplan-Meier disease-free survival curve stratified according to tumor location
    .
    Central type lung cancer means (a) the tumor in the inner third defined by the concentric line from the hilum; (b) the tumor in the inner third defined by the concentric line from the midline; (c) by Two-thirds of the tumor defined by the location index

    .

    Figure 3 Kaplan-Meier disease-free survival curve stratified according to tumor location
    .
    Central type lung cancer means (a) the tumor in the inner third defined by the concentric line from the hilum; (b) the tumor in the inner third defined by the concentric line from the midline; (c) by Two-thirds of the tumor defined by the location index

    .

    This study shows that , by the concentric lines defined hilar central lung cancer is poor prognosis independent of lymph node status prediction factors
    .
    The proposed definition of central tumor location based on quantification is
    an effective alternative method for predicting prognosis, and has higher time-dependent sensitivity and consistency between readers .
    The results of this study provide a reference for the clinically standardized and accurate definition of central lung cancer, and provide data support for accurate preoperative staging .


    This study shows that , by the concentric lines defined hilar central lung cancer is poor prognosis independent of lymph node status prediction factors
    .
    The proposed definition of central tumor location based on quantification is
    an effective alternative method for predicting prognosis, and has higher time-dependent sensitivity and consistency between readers .
    The results of this study provide a reference for the clinically standardized and accurate definition of central lung cancer, and provide data support for accurate preoperative staging .


    Original source:

    Original source:

    Hyewon Choi , Hyungjin Kim , Chang Min Park ,et al.
    Central Tumor Location at Chest CT Is an Adverse Prognostic Factor for Disease-Free Survival of Node-Negative Early-Stage Lung Adenocarcinomas .
    DOI: 10.
    1148/radiol.
    2021203937

    Hyewon Choi , Hyungjin Kim , Chang Min Park ,et al.
    Central Tumor Location at Chest CT Is an Adverse Prognostic Factor for Disease-Free Survival of Node-Negative Early-Stage Lung Adenocarcinomas .
    DOI: 10.
    1148/radiol.
    2021203937
    10.
    1148/radiol.
    2021203937


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