Objectives To compare clinical staging based on total tumor size with that of solid component size using the same criteria. Materials and methods Patients who underwent curative resection for clinical stage IA1-IB adenocarcinoma between 2011 and 2021 were retrospectively included. Patients were re-staged according to the criteria of the current TNM staging using total tumor size (cStagetotal) and solid component size (cStagesolid). Discrimination and prognostication for overall survival and freedom from recurrence were compared between cStagetotal and cStagesolid. The correlation with pathologic risk factors (high-grade pattern, lymphovascular invasion, and pathologic lymph node metastasis) was assessed. Results A total of 4680 patients were included. From cStagetotal to cStagesolid, 32.6% of patients (1525/4680) were downstaged. Overall survival stratification within clinical stage IA–3 for subsolid lesions was enabled only with cStagesolid. Both cStagetotal and cStagesolid demonstrated mortality risk stratification between neighboring stages from IA1 to IB (all p < 0.05); however, discrimination (C-index: 0.732 vs. 0.721) and prognostication (Akaike Information Criterion (AIC): 8609 vs. 8645; R2: 0.084 vs. 0.077) were better in cStagesolid. Additionally, cStagesolid showed an improved correlation with pathologic risk factors and pathologic lymph node metastasis (both any pN and pN2). cStagesolid also showed improved discrimination (C-index: 0.731 vs. 0.722) and prognostication (AIC: 12,257 vs. 12,316; R2: 0.102 vs. 0.091) than cStagetotal for freedom from recurrence. Conclusion Using the same size criteria, clinical staging based on solid component size provides enhanced performance and correlation with pathologic risk factors compared to total tumor size. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> A direct comparative validation of clinical staging based on solid component size versus total tumor size under the same criteria has not been conducted. <Emphasis Type="BoldItalic">Findings</Emphasis> Correlation with pathologic risk factors and lymph node metastasis, especially pN2, was stronger in clinical staging based on solid component. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> It is reasonable for future revisions to be based on the current scheme using solid component size. Graphical Abstract

Comparative validation of clinical staging based on solid component versus total tumor size in resected lung adenocarcinoma

期刊论文
发表日期：

2025年5月24日

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Yura Ahn,
Jae Kwang Yun,
Jooae Choe,
Geun Dong Lee,
SeHoon Choi,
Hyeong Ryul Kim,
Yong-Hee Kim,
Dong Kwan Kim,
Seung-Il Park

摘要

Objectives

To compare clinical staging based on total tumor size with that of solid component size using the same criteria.

Materials and methods

Patients who underwent curative resection for clinical stage IA1-IB adenocarcinoma between 2011 and 2021 were retrospectively included. Patients were re-staged according to the criteria of the current TNM staging using total tumor size (cStage_total) and solid component size (cStage_solid). Discrimination and prognostication for overall survival and freedom from recurrence were compared between cStage_total and cStage_solid. The correlation with pathologic risk factors (high-grade pattern, lymphovascular invasion, and pathologic lymph node metastasis) was assessed.

Results

A total of 4680 patients were included. From cStage_total to cStage_solid, 32.6% of patients (1525/4680) were downstaged. Overall survival stratification within clinical stage IA–3 for subsolid lesions was enabled only with cStage_solid. Both cStage_total and cStage_solid demonstrated mortality risk stratification between neighboring stages from IA1 to IB (all p < 0.05); however, discrimination (C-index: 0.732 vs. 0.721) and prognostication (Akaike Information Criterion (AIC): 8609 vs. 8645; R²: 0.084 vs. 0.077) were better in cStage_solid. Additionally, cStage_solid showed an improved correlation with pathologic risk factors and pathologic lymph node metastasis (both any pN and pN2). cStage_solid also showed improved discrimination (C-index: 0.731 vs. 0.722) and prognostication (AIC: 12,257 vs. 12,316; R²: 0.102 vs. 0.091) than cStage_total for freedom from recurrence.

Conclusion

Using the same size criteria, clinical staging based on solid component size provides enhanced performance and correlation with pathologic risk factors compared to total tumor size.

Key Points

Question A direct comparative validation of clinical staging based on solid component size versus total tumor size under the same criteria has not been conducted.

Findings Correlation with pathologic risk factors and lymph node metastasis, especially pN2, was stronger in clinical staging based on solid component.

Clinical relevance It is reasonable for future revisions to be based on the current scheme using solid component size.

Graphical Abstract