Predictors of pathological non-invasive lung cancer with pure-solid appearance on computed tomography to identify possible candidates for sublobar resection.

Abstract

This study aimed to establish favorable predictors for patients with clinical stage IA radiological pure-solid lung cancer to identify possible candidates for sublobar resection. We examined 275 patients with surgically resected clinical stage IA radiological pure-solid lung cancer. Pathological grade PL0, Ly0, V0, or N0 disease was defined as non-invasive pure-solid lung cancer (NIPS). Nodal involvement was observed in 63 (23%) patients with clinical stage IA pure-solid lung cancer, while NIPS was identified in 77 (28%). Multivariate analysis revealed that air bronchogram (p=0.0328), clinical T1a (p=0.0041), and SUVmax (p=0.0002) were significant clinical predictors of NIPS. When these clinical predictors were combined and the relevant patients' disease was classified as favorable, the frequency of nodal involvement was only 4%. Furthermore, the 3-year overall survival (OS) of the patients with "favorable" clinical stage IA pure-solid lung cancer was 100% despite their operative modes. In contrast, the 3-year OS even for patients with clinical stage IA disease, if they had neither of these clinical predictors, was 74.1%. Tumor size, the presence of air bronchogram, and the SUVmax level were significant favorable predictors of pathological non-invasive status, and patients with these clinical predictors could be candidates for sublobar resection for clinical stage IA pure-solid lung cancers.