Clinical Research Papers:
Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study
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Yunlang She1,*, Lilan Zhao1,*, Chenyang Dai1, Yijiu Ren1, Junyan Zha1, Huikang Xie2, Sen Jiang3, Jingyun Shi3, Shunbin Shi4, Weirong Shi5, Bing Yu6, Gening Jiang1, Ke Fei1, Yongbing Chen7 and Chang Chen1
1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
2 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
3 Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
4 Department of Thoracic Surgery, The Affiliated Wujiang Hospital of Nantong University, Jiangsu, P.R. China
5 Department of Thoracic Surgery, Nantong Sixth People’s Hospital, Jiangsu, P.R. China
6 Department of Thoracic Surgery, Fenghua People’s Hospital, Zhejiang, P.R. China
7 Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Jiangsu, P.R. China
* These authors have contributed equally to this work
Chang Chen, email:
Yongbing Chen, email:
Keywords: ground-glass nodule, lung adenocarcinoma, nomogram
Received: December 15, 2015 Accepted: June 04, 2016 Published: August 11, 2016
Purpose: To construct a preoperative nomogram to differentiate invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions in patients with solitary pure ground-glass nodules (GGN).
Methods: A primary cohort of patients with pathologically confirmed pulmonary solitary pure GGN after surgery were retrospectively studied at five institutions from January 2009 to September 2015. Half of the patients were randomly selected and assigned to a model-development cohort, and the remaining patients were assigned to a validation cohort. A nomogram predicting the invasive extent of the solitary GGNs was constructed based on the independent risk factors. Predictive performance was evaluated by concordance index (C-index) and calibration curve.
Results: Out of 898 cases included in the study, 501 (55.8%) were preinvasive lesions and 397 (44.2%) were IPAs. In the univariate analysis, lesion size (p < 0.001), lesion margin (p = 0.041), lesion shape (p < 0.001), mean computed tomography (CT) value (p = 0.018), presence of pleural indentation (p = 0.017), and smoking status (p = 0.014) were significantly associated with invasive extent. In multivariate analysis, lesion size (p < 0.001), lesion margin (p = 0.042), lesion shape (p < 0.001), mean CT value (p = 0.014), presence of pleural indentation (p = 0.026), and smoking status (p = 0.004) remained the predictive factors of invasive extent. A nomogram was developed and validation results showed a C-index of 0.94, demonstrating excellent concordance between predicted and observed results.
Conclusions: We established and validated a novel nomogram that can identify IPAs from preinvasive lesions in patients with solitary pure GGN.
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