Radiomic score is prognostic in clinical stage I lung adenocarcinoma ≤2 cm undergoing surgery.

Background: As sub-lobar resection becomes acceptable for lung cancer ≤2 cm, a preoperative marker of tumor aggressiveness to choose an appropriate extent of resection becomes necessary. We sought to assess the utility of Computer-Aided Nodule Assessment and Risk Yield (CANARY), a validated radiomic tool, in clinical stage I adenocarcinoma ≤2 cm.

Methods: We performed a retrospective review of resected lung cancer patients from 2016-2022. Our eligibility criteria included clinical stage I adenocarcinoma, availability of pre-operative computed tomography (CT) imaging, and a lesion size of ≤2 cm. Preoperative imaging was input into the CANARY program, and this was then used to categorize each lesion into good, intermediate, and poor. Kaplan-Meier curve was used to compare the recurrence-free survival (RFS). Descriptive statistics and log-rank tests were conducted to compare RFS between risk groups.

Results: Study population (n=134) had a median age of 68.6 and follow up of 2.9 years. By CANARY profile, 29 patients (21.6%) were good risk, 52 (38.8%) intermediate, and 53 (39.6%) poor. By procedure, 52 patients (38.8%) received wedge resections. Overall, the 3-year RFS was 96.3%, 92.0%, and 72.7% for patients with good, intermediate, and poor risks, respectively. There was a statistically significant difference in RFS between each risk group (χ=12.6, P=0.002). Patients with poor risk were associated with a significantly increased risk of recurrence relative to those with good/intermediate risks [hazard ratio (HR) =5.7, 95% confidence interval (CI): 1.9-17.5].

Conclusions: Poor risk on CANARY analysis is significantly associated with increased risk of recurrence after resection in clinical stage I adenocarcinoma lesions ≤2 cm.