Abstract

ObjectivesOur study aimed to validate pathologic findings of ground-glass nodules (GGOs) of different consolidation tumor ratios (CTRs), and to explore whether GGOs could be stratified according to CTR with an increment of 0.25 based on its prognostic role.MethodsWe retrospectively evaluated patients with clinical stage IA GGOs who underwent curative resection between 2011 and 2016. The patients were divided into 4 groups according to CTR step by 0.25. Cumulative survival rates were calculated by the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were conducted to obtain the risk factors on relapse-free survival (RFS). The surv_function of the R package survminer was used to determine the optimal cutoff value. Receiver operating characteristic (ROC) analysis was generated to validate optimal cutoff points of factors.ResultsA total of 862 patients (608 women; median age, 59y) were included, with 442 patients in group A (CTR ≤ 0.25), 210 patients in group B (0.25<CTR ≤ 0.5), 173 patients in group C (0.5<CTR ≤ 0.75), and 37 patients in group D (0.75<CTR<1). The rate of adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) in group A (70.6%) was much higher than other three groups (p<0.001). Multivariable Cox regression revealed that CTR (HR, 1.865; 95%CI, 1.312-2.650; p = 0.001) and lymph node metastasis (HR, 10.407; 95%CI, 1.957-55.343; p = 0.006) were independent prognostic factors for recurrence free survival. In addition, CTR was the only risk factor for the presence of micropapillary or solid pattern (OR=133.9, 95%CI:32.2-556.2, P<0.001) and lymph node metastasis (OR=292498.8, 95%CI:1.2-7.4×1010, P=0.047). Paired comparison showed that rate of presence of micropapillary or solid pattern was highest in group D, followed by group C and group A/B (p<0.001). Lymph node metastasis occurred in group D only (p=0.002).ConclusionsCTR is an independent prognostic factor for clinical stage IA lung adenocarcinoma manifesting as GGO in CT scan. Radiologic cutoffs of CTR 0.50 and 0.75 were able to subdivide patients with different prognosis.

Highlights

  • Ground glass opacity (GGO) is a radiological finding in computed tomography (CT) with a hazy opacity that does not obscure the underlying bronchial structures or pulmonary vessels [1,2,3]

  • Previous studies revealed that GGO dominant (CTR ≤ 0.5) part-solid nodules were less invasive than solid dominant (CTR>0.5) part-solid nodules [8,9,10,11,12,13,14]

  • It has been reported that these two poor differentiated components correlate with poor prognosis [16,17,18,19], and it has been verified in clinical stage I non-small-cell lung cancer as well [20,21,22]

Read more

Summary

Introduction

Ground glass opacity (GGO) is a radiological finding in computed tomography (CT) with a hazy opacity that does not obscure the underlying bronchial structures or pulmonary vessels [1,2,3]. Lung adenocarcinoma with GGO component is correlated with excellent prognosis [4]. Both consolidation size and consolidation tumor ratio (CTR) were reported to be prognostic factors for GGOs [5,6,7]. It has been reported that these two poor differentiated components correlate with poor prognosis [16,17,18,19], and it has been verified in clinical stage I non-small-cell lung cancer as well [20,21,22]. Few studies have investigated the pathologic subtypes of GGOs of different CTRs, with an increment of 0.25. Our study is to investigate prognostic factors of GGOs, and to explore whether GGOs should be studied according to CTR with an increment of 0.25, considering both survival and pathology

Objectives
Methods
Results
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call