The Value of Tumor Volume in Surgically Resected Non-Small Cell Lung Cancer

Abstract

Background: The aim of this study was to evaluate whether or not tumor volume (TV) has an impact on survival in non-small cell lung cancer. Methods: In a retrospective analysis of 385 cases with NSCLC who underwent curative surgery between 1994 and 2003, we calculated the tumor volume by using an ellipsoidal formula. The patients were grouped according to TV as determined by histograms. Gender, age, histology, nodal involvement, size, and TV were analyzed. Multivariate analysis by Cox's proportional hazards regression model was performed to identify the prognosis. Results: Cases of N0 showed a significantly lower TV than cases with other N statuses (p < 0.05). A significant difference was also observed between TV and histology or gender. The 189 patients belonging to the small volume group (SVG) (range, 0.105 to 9.265 cm³) had a significantly better overall survival rate than the other 196 patients in the large volume group (LVG) (9.266 - 366.522 cm³). With univariate analysis, gender, age, nodal involvement, size, and TV were significantly associated with prognosis. Multivariate analysis showed that only gender (p = 0.0184) and nodal involvement (p = 0.0001) were significantly independent prognostic factors. The size factor was not significant (p = 0.5285). However, TV was not an independent factor, but trending toward significance (p = 0.0801). Conclusions: Although TV provides no independent prognostic information with multivariate analysis, TV in NSCLC should be considered using volumetric measurement with a three-dimensional CT approach prior to surgery or treatment planning.

Key words

Tumor volume - non-small cell lung cancer

References

• 1 International Union against Cancer (UICC) .TNM Classification of Malignant Tumors. 5th ed. New York; Wiley-Liss 1997
• 2 Stamey T A, McNeal J E, Yemoto C M. et al . Biological determinants of cancer progression in men with prostate cancer.  JAMA. 1999;  281 135-400
• 3 McNeal J E, Bostwick D G, Kindrachuk R A. et al . Patterns of progression in prostate cancer.  Lancet. 1986;  1 60-63
• 4 Richtig E, Langmann G, Mullner K. et al . Calculated tumour volume as a prognostic parameter for survival in choroidal melanomas.  Eye. 2004;  18 619-623
• 5 Simi L, Andreani M, Davini F. et al . Simultaneous measurement of MMP9 and TIMP1 mRNA in human non[-]small cell lung cancer by multiplex real time RT-PCR.  Lung Cancer. 2004;  45 171-179
• 6 Minamoto H, Antonangelo L, da Silva A G. et al . Tumour cell and stromal features in metastatic and non-metastatic non-small cell lung carcinomas.  Histopathology. 2003;  43 427-443
• 7 Arinaga M, Noguchi T, Takeno S. et al . Clinical significance of vascular endothelial growth factor C and vascular endothelial growth factor receptor 3 in patients with non-small cell lung carcinoma.  Cancer. 2003;  97 457-464
• 8 Iwasaki A, Kuwahara M, Yoshinaga Y, Shirakusa T. Basis fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) levels, as prognostic indicators in NSCLC.  Eur J Cardiovasc Surg. 2004;  25 443-448
• 9 Yankelevitz D F, Reeves A P, Kostis W J. et al . Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation.  Radiology. 2000;  217 251-256
• 10 Jennings S G, Winer-Muram H T, Tarver R D, Farber M O. Lung tumor growth: assessment with CT - comparison of diameter and cross-sectional area with volume measurements.  Radiology. 2004;  231 866-871
• 11 Lopez-Encuentra A, Duque-Medina J L, Rami-Porta R. et al . Staging in lung cancer: Is 3 cm a prognostic threshold in pathologic stage I non-small cell lung cancer?.  Chest. 2002;  121 1515-1520
• 12 Carbone E, Asamura H, Takei H. et al . T2 tumors larger than five centimeters in diameter can be upgraded to T3 in non-small cell lung cancer.  J Thorac Cardiovasc Surg. 2001;  122 907-912
• 13 Kishi Y, Sugawara Y, Akamatsu N. et al . Sharing the middle hepatic vein between donor and recipient: left graft procurement preserving a large segment VIII branch in donor.  Liver Transplantation. 2004;  10 1208-1212
• 14 Werahera P N, Miller G J, Torkko K. et al . Biomorphometric analysis of human prostatic carcinoma by using three-dimensional computer models.  Hum Pathol. 2004;  35 798-807
• 15 Kikuchi E, Scardino P T, Wheeler T M. et al . Is tumor volume an independent prognostic factor in clinically localized prostate cancer?.  J Urol. 2004;  172 508-511
• 16 Yankelevitz D F, Reeves A P, Kistis W J. et al . Small pulmonary nodules: volumetrically determined growth rates based on CT evolution.  Radiology. 2000;  217 251-256
• 17 Vesselle H, Turcotte E, Wiens L. et al . Relationship between non-small cell lung cancer fluorodeoxyglucose uptake at positron emission tomography and surgical stage with relevance to patient prognosis.  Clin Cancer Res. 2004;  15 4709-4716
• 18 Daisne J F, Duprez T, Weynand B. et al . Tumor volume in pharyngolaryngeal squamous cell carcinoma: Comparison of CT, MR imaging, and FDG PET and validation with surgical specimen.  Radiology. 2004;  233 93-100
• 19 Thomas P, Doddoli C, Yena S. et al . VATS is adequate oncological operation for stage I non-small cell lung cancer.  Eur J Cardiothorac Surg. 2002;  21 1094-1099
• 20 Roviaro G, Varoli F, Vergani C. et al . Long-term survival after videothoracoscopic lobectomy for stage I lung cancer.  Chest. 2004;  126 725-732
• 21 Yamada S, Kohno T. Video-assisted thoracic surgery for pure ground-glass opacities 2 cm or less in diameter.  Ann Thorac Surg. 2004;  77 1911-1915
• 22 Plataniotis G A, Theofanopoulou M E, Kalogera-Fountzila A. et al . Prognostic impact of tumor volumetry in patients with locally advanced head and neck carcinoma (non-nasopharyngeal) treated by radiotherapy alone or combined radiochemotherapy in a randomized trial.  Int J Radiat Oncol Biol Phys. 2004;  15 1018-1026