Original Study|Articles in Press

Tumor Volume is a Better Prognostic Factor than Greatest Tumor Diameter in operated Stage I-III Non-small Cell Lung Cancer

Published:March 04, 2023DOI:
      • In the conventional TNM system only the great tumor diameter is taken into account to describe tumor size
      • Tumors do not always have a uniform shape and GTD can't always completely describe the true size of tumor especially which was irregular.
      • We suggest the hypotesis that TV might reflect the true tumor size better than GTD and we reported that TV can provide more prognostic information than GTD in patients with stage I-III NSCLC after complete resection.



      The aim of this study was to investigate the prognostic impact of tumor volume (TV, recorded from surgical specimens) on patients with stage I-III non-small cell lung cancer (NSCLC) after complete resection.


      129 patients with stage I-III NSCLC diagnosed and underwent curative resection from 2007 to 2014 in our center were included in the study. Their clinico-pathological factors were retrospectively reviewed. Overall survival (OS) and disease-free survival (DFS) analyses were performed with the Kaplan-Meier method and Cox's hazard model. According to the ROC analysis, patients were divided into two groups (Group 1: 58patients < 30.3 cm3 and Group 2: 71 patients ≥ 30.3 cm3) and the OS and DFS values were compared.


      Median TVs and greatest tumor diameter (GTD) were 12 cm3 (0.1-30) / 3cm (0.4-6.5) in Group 1 and 98 cm3 (30.6-1521) / 6 cm (3.5-21) in Group 2. Median OS was 53 (5-177) months in Group 1 and 38 (2-200) months in Group 2 (p<0.001). DFS was similar in both group [28 (1-140) vs 24 (1-155) months, p=0,489]. Kaplan-Meier curves showed significantly higher OS rates in Group 1 than Group 2 (p=0.04). In multivariable analysis (TV, tumor T stage, tumor N stage, receiving adjuvant radiotherapy) showed that TV (HR: 0.293, 95% CI: 0.121–0.707, p = 0.006) and tumor N stage (HR: 0.013, 95% CI:0.001-0.191, p=0.02) were independent factors associated with OS.


      Tumor volume, not considered in the routine TNM classification, may improve prediction accuracy of overall OS in operated Stage I-III NSCLC.

      Micro Abstract

      Tumor volume (TV), not considered in the routine TNM classification, may improve prediction accuracy of overall survival (OS) and disease free survival (DFS) in operated stage I-III non-small cell lung cancer (NSCLC). 129 patients with NSCLC diagnosed and underwent curative resection were examined and TV was independent factor for OS and DFS.


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