A Study on the Selection of Surgical Methods for ≤2cm Lung Adenocarcinomas Based on High-resolution CT Features Combined with Solid Component Size on MPVR

Abstract

Rationale and Objectives

The precise treatment methods for small early-stage lung cancer remain unclear. This study aims to analyze the high-resolution computed tomography (HRCT) imaging features and the size of the solid component in multiplanar volume reconstruction (MPVR) in depth, to select the optimal surgical approach (lobar resection or sublobar resection) for patients with lung adenocarcinomas ≤2cm, thereby optimizing clinical treatment strategies and improving patient prognosis.

Methods

A retrospective cohort of 657 consecutive patients with surgically resected lung adenocarcinoma was analyzed at the First Affiliated Hospital of Chongqing Medical University (2014–2023), comprising 345 lobar resection (52.5%) and 312 sublobar resection (47.5%) cases. All participants underwent standardized preoperative and postoperative HRCT examinations with consistent imaging protocols. The differences between the two groups of patients in terms of demographics, preoperative HRCT imaging features, clinical manifestations, postoperative pathological grading, and the 5-year recurrence-free survival rate and 5-year overall survival rate were compared. Based on the presence of spiculation and air bronchogram, pulmonary nodules were classified into four categories: nodules with both signs, nodules with spiculation but without air bronchogram, nodules with air bronchogram but without spiculation, and nodules without either sign. Significant variables (P<0.05) from univariate survival analysis were used to construct a multivariate Cox proportional hazards model, and Kaplan-Meier curves and log-rank tests were employed to compare survival rates between different groups.

Results

There was no statistically significant difference in the 5-year overall survival (OS, P=0.68) and 5-year recurrence-free survival (RFS, P=0.34) between the lobar and sublobar resection groups. Cox regression analysis revealed that spiculation (P<0.05), MPVR solid component >5.6 mm (P<0.05), and sublobar resection (P<0.05) were predictors of poorer survival, while air bronchogram was associated with better survival (P<0.05). Statistical results showed that patients with spiculation had a worse prognosis than those with air bronchogram (RFS: P<0.05, OS: P<0.05).

Conclusion

Spiculation, air bronchogram, and the diameter of the solid component in MPVR were significantly associated with patient prognosis. A tripartite management framework is proposed: 1) High-risk group (spiculation + solid component >5.6 mm): Lobectomy with systematic lymph node dissection. 2) Low-risk group (air bronchogram + solid component ≤5.6 mm): Sublobar resection or stereotactic body radiotherapy (SBRT). 3) Intermediate-risk group (single positive feature): Intraoperative frozen section-guided decision-making.