T1 invasive lung adenocarcinoma: Thin‑section CT solid score and histological periostin expression predict tumor recurrence

Iwamoto,Ryoji; Tanoue,Shuichi; Nagata,Shuji; Tabata,Kazuhiro; Fukuoka,Junya; Koganemaru,Masamichi; Sumi,Akiko; Chikasue,Tomonori; Abe,Toshi; Murakami,Daigo; Takamori,Shinzo; Ishii,Hidenobu; Ohshima,Koichi; Ohta,Shoichiro; Izuhara,Kenji; Fujimoto,Kiminori

doi:10.3892/mco.2021.2391

T1 invasive lung adenocarcinoma: Thin‑section CT solid score and histological periostin expression predict tumor recurrence

Authors:
- Ryoji Iwamoto
- Shuichi Tanoue
- Shuji Nagata
- Kazuhiro Tabata
- Junya Fukuoka
- Masamichi Koganemaru
- Akiko Sumi
- Tomonori Chikasue
- Toshi Abe
- Daigo Murakami
- Shinzo Takamori
- Hidenobu Ishii
- Koichi Ohshima
- Shoichiro Ohta
- Kenji Izuhara
- Kiminori Fujimoto
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Affiliations: Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan, Department of Pathology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki 852‑8523, Japan, Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan, Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan, Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan, Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga 849‑8501, Japan
Published online on: September 10, 2021 https://doi.org/10.3892/mco.2021.2391
Article Number: 228
Copyright: © Iwamoto et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Adenocarcinoma is the most common histological type of non‑small cell lung cancer (NSCLC), and various biomarkers for predicting its prognosis after surgical resection have been suggested, particularly in early‑stage lung adenocarcinoma. Periostin (also referred to as POSTN, PN or osteoblast‑specific factor) is an extracellular matrix protein, the expression of which is associated with tumor invasiveness in patients with NSCLC. In the present study, the novel approach, in which the thin‑section CT findings prior to surgical resection and periostin expression of resected specimens were analyzed in combination, was undertaken to assess whether the findings could be a biomarker for predicting the outcomes following resection of T1 invasive lung adenocarcinoma. A total of 73 patients who underwent surgical resection between January 2000 and December 2009 were enrolled. A total of seven parameters were assessed in the thin‑section CT scans: i) Contour; ii) part‑solid ground‑glass nodule or solid nodule; iii) percentage of solid component (the CT solid score); iv) presence of air‑bronchogram and/or bubble‑like lucencies; v) number of involved vessels; vi) shape linear strands between the nodule and the visceral pleura; and vii) number of linear strands between the nodule and the visceral pleura. Two chest radiologists independently assessed the parameters. Periostin expression was evaluated on the basis of the strength and extent of staining. Univariate and multivariate analyses were subsequently performed using the Cox proportional hazards model. There was a substantial to almost perfect agreement between the two observers with regard to classification of the seven thin‑section CT parameters (κ=0.64‑0.85). In the univariate analysis, a CT solid score >80%, pathological lymphatic invasion, tumor and lymph node status and high periostin expression were significantly associated with recurrence (all P<0.05). Multivariate analysis demonstrated that a CT solid score >80% and high periostin expression were risk factors for recurrence (P=0.002 and P=0.011, respectively). The cumulative recurrence rates among the three groups (both negative, CT solid score >80% or high periostin expression, or both positive) were significantly different (log‑rank test, P<0.001). Although the solid component is already known to be a major predictor of outcome in lung adenocarcinomas according to previous studies, the combined analysis of CT solid score and periostin expression might predict the likelihood of tumor recurrence more precisely.

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