Abstract
Lobectomy has been the standard surgical treatment for non-small cell lung cancer (NSCLC). Over the decades, with the dramatic development of radiographic tools, such as high-resolution computed tomography (HRCT), and the widespread practice of low-dose helical CT for screening, the number of cases diagnosed with small-cell lung cancers with ground glass opacity (GGO) at early stages has been increasing. Accordingly, mainly after 2000, many retrospective studies and prospective trials have shown that patients with lung adenocarcinoma with GGO have a good prognosis and may be candidates for sublobar resection. Previous studies indicated that HRCT findings including the maximum diameter of the tumor, GGO ratio, and a consolidation/tumor ratio (CTR) are simple and useful tools to predict tumor invasiveness and prognosis in patients with NSCLC with GGO. Thus, sublobar resection may be considered a “standard therapy” for peripheral GGO-dominant small-cell lung adenocarcinomas. Ultimately, some of such tumors might not require surgical resection. A multicenter, prospective study has just begun in Japan to evaluate the validity of follow-up for small-sized GGO-dominant small-cell lung cancer. Lung cancers that do not require surgery should be identified. This study reviewed retrospective and prospective studies on GGO tumors and discussed the treatment strategies for such tumors.
Highlights
Lobectomy has been the standard surgical treatment for non-small cell lung cancer (NSCLC), even when it is in its early stage
We revealed that ground glass opacity (GGO)-dominant clinical stage IA lung adenocarcinomas are a uniform group of tumors that exhibit low-grade malignancy and have an extremely favorable prognosis and can be successfully treated with sublobar resection
GGO-dominated tumors of 21-30 mm rarely showed pathological invasiveness, and there was no difference in survival analysis, for tumors of 21-30 mm, where GGO predominates, 3-year recurrence-free survival (RFS) was similar in patients who underwent lobectomy (93.7%) and segmentectomy (92.9%)
Summary
Lobectomy has been the standard surgical treatment for non-small cell lung cancer (NSCLC), even when it is in its early stage. In 1995, a randomized trial reported that sublobar resection for stage IA NSCLC did not result in improved morbidity, mortality, or postoperative pulmonary function and was associated with higher rates of locoregional recurrence and death relative to lobectomy [2]. In this trial, in patients who underwent sublobar resection, recurrence showed a 75% increase (p = 0.02) attributable to a tripling of the local recurrence rate (p = 0.008), 30% increase in overall death rate (p = 0.08), and 50% increase in death due to cancer (p = 0.09) compared to patients undergoing lobectomy. We evaluated appropriate treatment strategy for NSCLC with GGO
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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
