The impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity

Abstract

Objective The purpose of this study is to evaluate the impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity. Methods We reviewed the clinical data of 3254 surgically resected c-stage I lung cancer patients, 312 (9.6%)with multiple lung tumors. All patients were classified into 3 groups based on the extent of ground glass opacity (GGO) and consolidation tumor ratio (CTR), including GGO-dominant (GD)(0 ≤CTR < 0.5), solid-dominant (SD) (0.5 ≤CTR < 1.0) , and pure-solid (PS) (CTR =1.0). Patients with multiple lung tumors were divided into 6 groups based on imaging findings, including GD+ GD group, GD+ SD group, GD+ PS group, SD+ SD group, SD+ PS group and PS+ PS group , and their prognoses were compared with that of c-stage I lung cancer using Cox’s proportional hazard model. Results Among all, 251(80.4%) have surgically resected more than two tumors and pathologically determined as multiple lung cancers patients . Among 312 patients , 90 in GD+ GD group (28.8%), 70 in GD + SD group(22.4%), 66 in GD+ PS group(21.2%), 16 in SD + SD group(5.1%), 27 in SD+ PS group(8.7%), and 43 in PS + PS group(13.8%). Based on the results of multivariate analyses, PS+ PS revealed the independent risk factors for prognosis impact(P<0.001). The overall survival rate (OS) was 96.7% in group GD+ GD, 98.6% in group GD + SD, 84.8% in group GD+ PS , 93.8% in group SD+ SD , 77.8% in group SD+ PS , 41.9% in group PS + PS , which showing a significant difference between PS+ PS group and the other groups (P<0.05). Conclusions Among all patients with multiple lung cancers, patients in PS+ PS group have lower survival rate, which would contribute to the upstaging of T descriptors. The imaging findings of GGO and its classifications are extremely important to prognosis evaluation. Key words: Multiple lung cancers; Ground glass opacity; Imaging findings; Prognosis