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J Thorac Cardiovasc Surg 2002;124:1014-1020
© 2002 The American Association for Thoracic Surgery
General Thoracic Surgery (GTS) |
From the Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan,a the Department of Thoracic Surgery, The First Teaching Hospital affiliated with China Medical University, Shenyang, China,b the Department of Surgery, Sendai Kosei Hospital, Sendai, Japan,c the Department of Endoscopy, Toyama Medical and Pharmaceutical University, Toyama, Japan,d and the Department of Thoracic Surgery, Kanazawa Medical University, Kanazawa, Japan.e
Received for publication Nov 5, 2001. Revisions requested Feb 5, 2002; revisions received Feb 13, 2002. Accepted for publication April 16, 2002. Address for reprints: Masami Sato, MD, Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan (E-mail: m-sato{at}idac.tohoku.ac.jp).
Objectives: The purpose of this study was to determine whether the ratio of the area of the mediastinal computed tomographic image to that of the lung computed tomographic image can be a prognostic factor of small peripheral lung adenocarcinoma.
Methods: We studied the computed tomographic images of 143 patients with primary peripheral lung adenocarcinoma of 30 mm or less in maximum diameter. Two groups were categorized according to the tumor's ratio of the area of the mediastinal computed tomographic image to that of the lung computed tomographic image (tumor's area in the mediastinal computed tomographic image/tumor's area in lung computed tomographic image x 100%), both faint density-type (<50%) and solid-type images (
50%). Clinical factors and prognoses of the 2 groups were analyzed.
Results: There were 58 patients with the solid-type tumor image and 85 patients with the faint density-type tumor image. The number of patients with tumor size of less than 20 mm in the faint density-type tumor group (n = 30) was significantly higher than that in the solid-type tumor group (n = 8, P = .008). The 5-year survival of patients with faint density-type tumors was 74.1%, whereas that in patients with solid-type tumors was 54.2% (P = .013). Furthermore, the survival curve of patients with the solid-type computed tomographic image combined with ground-glass opacity was similar to that of patients with the faint density-type image. Multivariate analysis revealed the prognostic influence of the ratio of the area of the mediastinal computed tomographic image to that of the lung computed tomographic image on survival (P = .029, relative risk = 0.48) and showed to be of second highest influence after the N factor.
Conclusions: It is suggested that the ratio of the area of the mediastinal computed tomographic image to that of the lung computed tomographic image can be a prognostic factor in patients with small peripheral lung adenocarcinoma.
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