1Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
2Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Korea
3Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
4Department of Applied Statistics, University of Suwon, Hwaseong, Korea
Copyright © 2022 by the Korean Cancer Association
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This retrospective preliminary study was approved (approval number: CUH-2020-11-004) by the institutional review board of the Chonbuk National University Hospital (Jeonju, Korea). The requirement for informed consent was waived due to the retrospective nature of this study. This research was conducted in accordance with the principles of the Declaration of Helsinki and its later amendments.
Author Contributions
Conceived and designed the analysis: Chae KJ, Choi H, Jeong WG, Kim J.
Collected the data: Chae KJ.
Contributed data or analysis tools: Choi H, Kim J.
Performed the analysis: Choi H, Kim J.
Wrote the paper: Chae KJ, Choi H, Jeong WG, Kim J.
Conflicts of Interest
Conflict of interest relevant to this article was not reported.
Variable | Included patients (n=612) |
---|---|
Sex | |
Female | 188 (30.7) |
Male | 424 (69.3) |
Age (yr) 66.0±9.4 | |
History of malignancy other than lung cancer | |
No | 513 (83.8) |
Yes | 99 (16.2) |
Family history of lung cancer | |
No | 586 (95.8) |
Yes | 26 (4.2) |
Smoking history | |
Never smoker | 267 (43.6) |
Former or current smoker | 345 (56.4) |
Nodule location | |
Upper and middle lobes | 366 (59.8) |
Lower lobes | 246 (40.2) |
TNM stagea) | |
1A | 294 (48.0) |
1B | 75 (12.3) |
2A | 36 (5.9) |
2B | 97 (15.8) |
3A | 88 (14.4) |
3B | 21 (3.4) |
3C | 1 (0.2) |
Pathologic diagnosis | |
Squamous cell carcinoma | 230 (37.6) |
Adenocarcinoma | 382 (62.4) |
Operation method | |
Lobectomy | 559 (91.3) |
Bilobectomy or pneumonectomy | 53 (8.7) |
Treatment | |
Operation only | 323 (52.8) |
Adjuvant chemo- or radiation therapy | 289 (47.2) |
Relapse | |
No | 415 (67.8) |
Yes | 146 (23.9) |
Loss to follow-up | 51 (8.3) |
Death | |
Alive | 426 (69.6) |
Death (lung cancer) | 155 (25.3) |
Death (with a cause other than lung cancer) | 31 (5.1)b) |
Variable | Relapse | Death without relapse | Death after relapse | |||
---|---|---|---|---|---|---|
|
|
|
||||
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (yr) | 1.02 (1.00–1.04) | 0.115 | 1.07 (1.03–1.11) | < 0.001 | - | - |
|
||||||
Former or current smoker | - | - | 4.05 (1.95–8.39) | < 0.001 | - | - |
|
||||||
History of malignancy other than lung cancer | 1.67 (1.07–2.6) | 0.023 | - | - | - | - |
|
||||||
Location at a lower lobe | 0.63 (0.44–0.89) | 0.009 | 1.97 (1.17–3.32) | 0.011 | - | - |
|
||||||
Pneumonectomy (reference: lobectomy) | 1.97 (1.20–3.23) | 0.007 | 2.58 (1.26–5.28) | 0.009 | 1.84 (1.03–3.28) | 0.039 |
|
||||||
TNM stage (reference: 1A) | ||||||
|
||||||
1B | 1.19 (0.58–2.42) | 0.632 | 2.42 (1.1–5.32) | 0.027 | - | - |
|
||||||
2A | 2.98 (1.32–6.73) | 0.009 | 2.30 (0.71–7.44) | 0.164 | - | - |
|
||||||
2B | 3.55 (1.80–7.01) | < 0.001 | 3.16 (1.38–7.23) | 0.007 | - | - |
|
||||||
3A | 5.26 (2.61–10.59) | < 0.001 | 11.20 (4.61–27.21) | < 0.001 | - | - |
|
||||||
3B or 3C | 12.06 (5.35–27.22) | < 0.001 | 16.35 (5.47–48.91) | < 0.001 | - | - |
|
||||||
Interaction of cancer type and treatment (reference: SqCC and operation only) | ||||||
|
||||||
SqCC and adjuvant therapy | 0.62 (0.29–1.32) | 0.214 | 0.10 (0.05–0.23) | < 0.001 | - | - |
|
||||||
ADC and operation only | 0.44 (0.21–0.92) | 0.029 | 0.44 (0.22–0.89) | 0.022 | 0.52 (0.33–0.83)a) | 0.006 |
|
||||||
ADC and adjuvant therapy | 1.65 (0.83–3.28) | 0.157 | 0.17 (0.07–0.40) | < 0.001 |
Patient demographic and medical characteristics
Variable | Included patients (n=612) |
---|---|
Sex | |
Female | 188 (30.7) |
Male | 424 (69.3) |
Age (yr) 66.0±9.4 | |
History of malignancy other than lung cancer | |
No | 513 (83.8) |
Yes | 99 (16.2) |
Family history of lung cancer | |
No | 586 (95.8) |
Yes | 26 (4.2) |
Smoking history | |
Never smoker | 267 (43.6) |
Former or current smoker | 345 (56.4) |
Nodule location | |
Upper and middle lobes | 366 (59.8) |
Lower lobes | 246 (40.2) |
TNM stage |
|
1A | 294 (48.0) |
1B | 75 (12.3) |
2A | 36 (5.9) |
2B | 97 (15.8) |
3A | 88 (14.4) |
3B | 21 (3.4) |
3C | 1 (0.2) |
Pathologic diagnosis | |
Squamous cell carcinoma | 230 (37.6) |
Adenocarcinoma | 382 (62.4) |
Operation method | |
Lobectomy | 559 (91.3) |
Bilobectomy or pneumonectomy | 53 (8.7) |
Treatment | |
Operation only | 323 (52.8) |
Adjuvant chemo- or radiation therapy | 289 (47.2) |
Relapse | |
No | 415 (67.8) |
Yes | 146 (23.9) |
Loss to follow-up | 51 (8.3) |
Death | |
Alive | 426 (69.6) |
Death (lung cancer) | 155 (25.3) |
Death (with a cause other than lung cancer) | 31 (5.1) |
Values are presented as number (%) or mean±standard deviation.
a)The pathologic T categorization was based on the eighth edition staging system for lung cancer,
b)Patients were classified as censored at the time of death.
Multivariable analysis for the disease-free survival model based on the Akaike information criterion in the patients with lung cancer
Variable | Disease-free survival model | |
---|---|---|
HR (95% CI) | p-value | |
Age (yr) | 1.03 (1.01–1.05) | 0.001 |
Former or current smoker | 1.68 (1.22–2.32) | 0.001 |
History of malignancy other than lung cancer | 1.44 (1.00–2.06) | 0.049 |
Pneumonectomy (reference: lobectomy) | 2.09 (1.41–3.11) | < 0.001 |
TNM stage (reference: 1A) | ||
1B | 1.62 (0.96–2.71) | 0.070 |
2A | 3.17 (1.66–6.05) | < 0.001 |
2B | 3.94 (2.36–6.59) | < 0.001 |
3A | 7.38 (4.29–12.70) | < 0.001 |
3B or 3C | 15.41 (8.08–29.4) | < 0.001 |
Interaction of cancer type and treatment (reference: SqCC and operation only) | ||
SqCC and adjuvant therapy | 0.26 (0.16–0.44) | < 0.001 |
ADC and operation only | 0.39 (0.24–0.65) | < 0.001 |
ADC and adjuvant therapy | 0.72 (0.45–1.15) | 0.170 |
ADC, adenocarcinoma; Adjuvant therapy, adjuvant chemo- or radiation therapy; CI, confidence interval; HR, hazard ratio; SqCC, squamous cell carcinoma.
Multivariable analysis for the illness-death model based on the Akaike information criterion in patients with lung cancer
Variable | Relapse | Death without relapse | Death after relapse | |||
---|---|---|---|---|---|---|
|
|
| ||||
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (yr) | 1.02 (1.00–1.04) | 0.115 | 1.07 (1.03–1.11) | < 0.001 | - | - |
| ||||||
Former or current smoker | - | - | 4.05 (1.95–8.39) | < 0.001 | - | - |
| ||||||
History of malignancy other than lung cancer | 1.67 (1.07–2.6) | 0.023 | - | - | - | - |
| ||||||
Location at a lower lobe | 0.63 (0.44–0.89) | 0.009 | 1.97 (1.17–3.32) | 0.011 | - | - |
| ||||||
Pneumonectomy (reference: lobectomy) | 1.97 (1.20–3.23) | 0.007 | 2.58 (1.26–5.28) | 0.009 | 1.84 (1.03–3.28) | 0.039 |
| ||||||
TNM stage (reference: 1A) | ||||||
| ||||||
1B | 1.19 (0.58–2.42) | 0.632 | 2.42 (1.1–5.32) | 0.027 | - | - |
| ||||||
2A | 2.98 (1.32–6.73) | 0.009 | 2.30 (0.71–7.44) | 0.164 | - | - |
| ||||||
2B | 3.55 (1.80–7.01) | < 0.001 | 3.16 (1.38–7.23) | 0.007 | - | - |
| ||||||
3A | 5.26 (2.61–10.59) | < 0.001 | 11.20 (4.61–27.21) | < 0.001 | - | - |
| ||||||
3B or 3C | 12.06 (5.35–27.22) | < 0.001 | 16.35 (5.47–48.91) | < 0.001 | - | - |
| ||||||
Interaction of cancer type and treatment (reference: SqCC and operation only) | ||||||
| ||||||
SqCC and adjuvant therapy | 0.62 (0.29–1.32) | 0.214 | 0.10 (0.05–0.23) | < 0.001 | - | - |
| ||||||
ADC and operation only | 0.44 (0.21–0.92) | 0.029 | 0.44 (0.22–0.89) | 0.022 | 0.52 (0.33–0.83) |
0.006 |
| ||||||
ADC and adjuvant therapy | 1.65 (0.83–3.28) | 0.157 | 0.17 (0.07–0.40) | < 0.001 |
ADC, adenocarcinoma; Adjuvant therapy, adjuvant chemo- or radiation therapy; CI, confidence interval; HR, hazard ratio, SqCC, squamous cell carcinoma.
a)HR of ADC relative to SqCC, ignoring treatment.
Values are presented as number (%) or mean±standard deviation. The pathologic T categorization was based on the eighth edition staging system for lung cancer, Patients were classified as censored at the time of death.
ADC, adenocarcinoma; Adjuvant therapy, adjuvant chemo- or radiation therapy; CI, confidence interval; HR, hazard ratio; SqCC, squamous cell carcinoma.
ADC, adenocarcinoma; Adjuvant therapy, adjuvant chemo- or radiation therapy; CI, confidence interval; HR, hazard ratio, SqCC, squamous cell carcinoma. HR of ADC relative to SqCC, ignoring treatment.