Presence Of Ground Glass Opacity Component Research Articles

Effect of ground-glass opacity components on the recurrence of pathological stage IB non-small cell lung cancer harboring epidermal growth factor receptor mutations.

This study aimed to examine the influence of ground-glass opacity (GGO) on the prognosis of epidermal growth factor receptor (EGFR)-mutated pathological (p)-stage IB non-small cell lung cancer (NSCLC). Between 2009 and 2021, 115 patients underwent complete anatomical lung resection with mediastinal lymphadenectomy for p-stage IB non-squamous NSCLC harboring common EGFR mutations. The patients were classified into the part-solid and pure-solid arms based on the presence of GGO components. The median follow-up time was 70.2months. Sixty-seven patients (58%) had pure-solid tumors and 112 (97%) were diagnosed with adenocarcinoma. No patients received adjuvant EGFR-tyrosine kinase inhibitors (TKIs). The 5-year disease-free survival (DFS) rates in the pure-solid arm were significantly lower than those in the part-solid arm (5-year DFS: 45.3% vs. 86.8%, p < 0.01). The 5-year cumulative incidence of recurrence was higher in the pure-solid arm than that in the part-solid arm (49.9% vs. 9.0%, p < 0.01). A multivariable analysis revealed that pure-solid tumors were an independent prognostic predictor of disease-free survival, whereas pathological factors were not. In EGFR-mutated p-stage IB NSCLC, pure-solid tumors were significant predictors of DFS. The presence of GGO components should be considered in the decision criteria for adjuvant therapy with TKIs.

Reassessment of the Prognostic Implication of Ground-Glass Opacity: An Investigation Into Hypermetabolic Clinical Stage IA Lung Adenocarcinoma.

Subsolid lung nodules represent a distinct group of lung cancers with less-aggressive biological behavior and favorable survival. We aimed to examine the prognostic impact of the ground-glass opacity (GGO) in clinical stage IA (cIA) lung adenocarcinoma with high metabolic activity. A retrospective study was conducted among patients with resected hypermetabolic and/or pure-solid cIA lung adenocarcinoma from a single institution database. The primary outcome was recurrence-free survival (RFS). The secondary outcomes included overall survival, pathological nodal upstaging, and recurrence rate. A total of 621 patients were reviewed and classified into three groups: patients with low metabolic, solid nodules (SNs) into group A (N = 128), patients with hypermetabolic ground-glass nodules (GGNs) into group B (N = 105), and patients with hypermetabolic SNs into group C (N = 388). The five-year RFS of group B was significantly better than that of group C in the cT1a + T1b (93.3% vs. 72.5%, p = 0.002) subgroup but not in the cT1c (73.4% vs. 69.0%, p = 0.23) subgroup. Multivariable analysis showed that GGO component was an independent prognostic factor of RFS (hazard ratio [HR] = 0.41, 95% confidence interval [CI]: 0.19-0.89, p = 0.02) and protective factor of nodal upstaging (odds ratio [OR] = 0.44, 95% CI: 0.21-0.94, p = 0.03) among the hypermetabolic subgroup. All except one postoperative recurrence occurred in GGNs with solid component size > 2 cm. The presence of GGO component was an independent prognostic factor even in hypermetabolic cIA lung adenocarcinoma. However, the oncologic outcomes of hypermetabolic GGNs were not equally favorable in different T categories.

Resected lung adenocarcinoma with lymph node metastasis: is ground glass opacity component a prognostic factor?

Ground glass opacity (GGO)-featured lung adenocarcinoma generally has excellent prognosis, and here is rarely the occurrence of lymph node metastasis. We conducted a retrospective cohort study to explore the prognostic impact of GGO component in node-positive lung adenocarcinomas. A total of 669 patients with pathologic N1/N2 lung adenocarcinoma receiving R0 resection and systemic lymph node dissection from 2008 to 2015 were reviewed, including 635 solid and 34 part-solid lesions. Propensity score matching (PSM) was performed to compare survival outcomes of solid and part-solid lesions, in order to determine the prognostic value of GGO component. Cox proportional hazard model was performed to identify significant prognostic factors for resected node positive lung adenocarcinoma. About 5.1% (34 of 669) of resected node-positive lung adenocarcinoma presented as part-solid nodules on computed tomography (CT) images in this cohort. The median nodule size on CT of the 34 part-solid lesions was 31 mm (range, 15-68 mm), median solid component size on CT was 24 mm (range, 12-62 mm), and median consolidation/tumor ratio was 0.8 (range, 0.64-0.95). After 1:4 PSM, 136 patients and 34 patients were matched from the solid and part-solid groups. No significant difference in either recurrence-free survival (RFS) (P=0.71) or overall survival (OS) (P=0.82) was found between the solid and part-solid groups. Multivariable Cox regression showed that pN stage was the strongest prognostic factor for RFS and OS. GGO component was not an independent prognostic factor toward for RFS [P=0.75; hazard ratio (HR) =0.93; 95% confidence interval (CI): 0.59-1.46] or OS (P=0.53; HR =1.19; 95% CI: 0.69-2.05). A minority of resected node-positive lung adenocarcinoma presents as GGO component on CT. The presence of GGO component does not predict better prognosis in node-positive lung adenocarcinoma.

Oncological characteristics of epidermal growth factor receptor–mutated clinical stage IA lung adenocarcinoma with radiologically pure-solid appearance

ObjectivesWe evaluated the clinicopathological and oncological characteristics of epidermal growth factor receptor–mutated clinical stage IA radiological pure-solid lung adenocarcinoma and compared them with those of a ground-glass opacity component. MethodsBetween 2008 and 2020, data from 1014 surgically resected clinical stage 0-IA epidermal growth factor receptor–mutated lung adenocarcinomas were evaluated. Oncological outcomes were assessed using multivariable analysis. Overall survival was estimated using Kaplan–Meier analysis and the log-rank test. The cumulative incidence of recurrence was estimated using the Gray's test. ResultsOf these, 233 (23%) were radiologically pure-solid tumors, which demonstrated a higher proportion of nodal metastasis, micropapillary component, spread through alveolar space, and Ex19 subtype compared with those of tumors with ground-glass opacity (P < .001). Multivariable analysis revealed that the presence of ground-glass opacity was an independently significant factor for overall survival (P = .037) and cumulative incidence of recurrence (P < .001). In cases where the oncological outcomes were stratified by the presence of ground-glass opacity component, the 5-year overall survival was excellent at more than 90% in tumors with ground-glass opacity despite clinical-T categories (P = .2044); however, tumor size significantly affected survival only in pure-solid tumors (T1a, 100%; T1b, 77.7%; T1c, 68.5%; P = .0056). Furthermore, the cumulative incidence of recurrence was low in tumors with ground-glass opacity despite the clinical-T categories, whereas tumor size significantly affected the cumulative incidence of recurrence only in pure-solid tumors (5-year cumulative incidence of recurrence: T1a-b, 18.9%; T1c, 41.3%; P < .001). ConclusionsOncologic behavior and prognosis of radiologically pure-solid tumors were significantly poorer than those of tumors with ground-glass opacity among patients with epidermal growth factor receptor–mutated early-stage lung adenocarcinoma. These findings imply distinct tumorigenesis based on the presence of ground-glass opacity, even in tumors with epidermal growth factor receptor mutations.

Prognostic Factors for Survival of Stage IB Non-small Cell Lung Cancer Patients: A 10-Year Follow-Up Retrospective Study.

This study aimed to determine the prognostic factors for the long-term outcome of stage IB non-small cell lung cancer (NSCLC). Surgically resected patients with stage IB NSCLC diagnosed (based on TNM 8th edition) between April 2008 and December 2013 were retrospectively reviewed. The prognosis and possible risk factors among the stage IB NSCLC patients were evaluated. Of the 349 patients identified for the study, 80 (22.9%) received post-surgery adjuvant chemotherapy (ACT). The median follow-up time after surgery was 123.3 months. The 10-year overall survival (OS) rate was 69.6%, and the 10-year recurrence-free survival (RFS) rate was 62.8%. The patients in this cohort were divided into three groups (T1 with visceral pleural invasion [VPI], T2a without VPI, and T2a with VPI), and no significant differences in OS or RFS were found among the groups. Furthermore, survival analysis indicated that the absence of ground-glass opacity (GGO) components portends an adverse long-term OS and RFS. In a subgroup of patients with solid nodules, age older than 65 years (hazard ratio [HR] 1.987; 95% confidence interval [CI] 1.312-3.010; p = 0.001) and ACT (HR 0.392; 95% CI 0.225-0.684; p < 0.001) were independent prognostic factors for OS, whereas lymphovascular invasion (HR 1.792; 95% CI 0.995-3.227; p = 0.052) should be considered as an independent unfavorable prognostic factor for RFS. As an upstaging factor, VPI did not further stratify prognosis for the stage IB patients in our cohort. The presence of GGO components had a notable impact on a favorable prognosis in stage IB NSCLCs.

Effects of a ground-glass opacity component on the recurrence and survival of pathological stage IA3 lung adenocarcinoma: a multi-institutional retrospective study.

This study aimed to evaluate the effect of the presence of a radiographically manifested ground-glass opacity (GGO) component on the prognosis of patients with pathological stage IA3 lung adenocarcinoma. Patients diagnosed with pathological stage IA3 lung adenocarcinoma who underwent radical surgery at two medical institutions in China between July 2012 and July 2020 were enrolled. The cumulative incidence of recurrence (CIR) and cumulative incidence of death (CID) in patients with and without a GGO component were compared. Risk curves for the recurrence and tumor-related death overtime were analyzed between the two groups according to life table. In order to validate the prognostic value of GGO components, the recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated. Decision curve analysis (DCA) was performed to evaluate the clinical benefit rate of different models. Among the 352 included patients, the presence of a GGO component was radiographically shown in 166 (47.2%) patients, while 186 (52.8%) displayed solid nodules. Patients exhibiting the absence of a GGO component had higher incidences of total recurrence (17.2% vs. 3.0%, P<0.001), local-regional recurrence (LRR) (5.4% vs. 0.6%, P=0.010), distant metastasis (DM) (8.1% vs. 1.8%, P=0.008), and multiple recurrences (4.3% vs. 0.6%, P=0.028) than the presence-GGO component group. The 5-year CIR and CID were 7.5% and 7.4% in the presence-GGO component group, and 24.5% and 17.0% in the absence-GGO component group, respectively, with statistically significant differences between the two groups (P<0.05). The risk of recurrence in patients with the presence of GGO components showed a single peak at 3 years postoperatively, while patients with the absence of GGO components showed a double peak at 1 and 5 years after surgery, respectively. However, the risk of tumor-related death peaked in both groups at 3 and 6 years postoperatively. Multivariate Cox analysis showed that the presence of a GGO component was a favorable independent risk factor for pathological stage IA3 lung adenocarcinoma patients (P<0.05). Pathological stage IA3 lung adenocarcinoma with or without GGO components are two types of tumors with different invasive abilities. In clinical practice, we should develop different treatment and follow-up strategies.

Distinct clinicopathologic factors and prognosis based on the presence of ground-glass opacity components in patients with resected stage I non-small cell lung cancer.

BackgroundThis study was to investigate the prognostic value of ground-glass opacity(GGO) components and to evaluate distinct the clinicopathological variables of survival outcomes for the pure-GGO, part-solid and solid groups of patients with resected stage I non-small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed the structured data for stage I NSCLC patients who had undergone the curative-intent surgical resection in the Lung Cancer Database of West China Hospital from 2009 to 2016. The eligible patients were divided into the pure-GGO, part-solid and solid groups according to the radiological manifestation. Univariate and multivariate Cox regression analyses were performed between the 3 groups. And we further evaluated the clinicopathological variables in each group separately.ResultsAmong a total of 2,775 eligible patients enrolled into the cohort were 1,587 (57.19%) in the solid group, 508 (18.31%) in the part-solid group, and 680 (24.50%) in the pure-GGO group. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 98.8% and 98.0% in the pure-GGO group, 96.0% and 86.5% in the part-solid group, and 88.0% and 75.5% in the solid group, respectively (P<0.001). Presence of GGO components was a significantly favorable prognosticator (HR =0.415, 95% CI: 0.286–0.601). Different groups had distinct prognostic factors. LVI was the shared risk factor for groups with presence of GGO components in both part-solid and pure-GGO groups. Pathological stage (IA or IB) was influential exclusively for the pure-GGO group. In the solid group, females, younger patients, and patients without VPI had better survival. But such independent significance did not exist in the other two groups.ConclusionsGGO component was a strong prognosticator of better prognosis in resected patients with stage I NSCLC. Prognostic factors and survival outcomes were disparate among the pure-GGO, part-solid, and solid group. Our results support the proposal that the next edition tumor-node-metastasis (TNM) classification should consider the importance of GGO components as a new T descriptor.

A modified T categorization for part-solid lesions in Chinese patients with clinical stage I Non–small cell lung cancer

ObjectivesWe evaluated the prognostic impact of the presence of ground glass opacity (GGO) component and compared a modified clinical T categorization (cTm) with the current 8th classification (cT8) for survival prediction in Chinese patients with clinical stage I non–small cell lung cancer (NSCLC). MethodsAccording to cTm and cT8 classifications, we retrospectively evaluated 1461 patients with part-solid or pure-solid lesions. The recurrence-free survival (RFS) and overall survival (OS) were analyzed by Kaplan-Meier method and Cox proportional hazard model. The concordance index (C- index), reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) were performed to estimate reclassification net benefits of cTm for survival prediction. ResultsThe cT8 classification clearly stratifies the survival outcomes in solid tumors but not in part-solid tumors. The presence of GGO components was an independent prognostic factor for both RFS and OS (p < 0.001), indicating a better outcome in each clinical T stage. The C-index was significantly improved from 0.650 to 0.730 for RFS (p < 0.001) and 0.647 to 0.730 for OS (p < 0.001) after reclassifying by cTm categorization. The DCA, NRI (RFS: 0.342, OS: 0.302), and IDI (RFS: 0.070, OS: 0.054) demonstrated that the cTm classification provided more net benefit in the survival prediction compared with the current cT8 classification. ConclusionsThe current cT8 classification may not be appropriate for part-solid lesions because the presence of GGO components is associated with excellent prognosis despite clinical stage. Also, the cTm classification for part-solid lesions showed an improvement in survival prediction.

Prognostic Classification of Multiple Primary Lung Cancers Based on a Ground-Glass Opacity Component

We evaluated the prognostic impact of the presence of a ground-glass opacity (GGO) component on thin-section computed tomography for the refined clinical T classification of multiple primary lung cancers. We reviewed 272 surgically resected, clinically node-negative multiple lung cancers. Dominant tumors were classified into 2 groups based on the presence of a GGO component; that is, a GGO tumor (consolidation tumor ratio, 0 to <1.0) or pure-solid (PS) tumor (consolidation tumor ratio, 1.0). Furthermore, multifocal GGOs (MFGGOs) were defined as lesions showing a GGO component for all tumors. Their prognoses were evaluated using Cox proportional hazard model. There were 153 MFGGOs (56%) with a significantly better 5-year overall survival than non-MFGGOs (97.2% vs 68.5%, P < .001). A multivariable analysis revealed that MFGGO and absence of nodal involvement were independently significant prognosticators of better survival (P= .007 and P= .012, respectively). Furthermore, among the patients of non-MFGGO groups, multivariate analysis showed that a PS+ PS pattern and presence of nodal involvement were independently significant prognosticators of poorer survival (P= .008 and P= .001, respectively). We divided the tumors into 3 groups based on the results and focusing on the presence of a GGO; that is, MFGGO (n= 153), PS+ additional GGO (n= 81), and PS+ PS (n= 38). The 5-year overall survival was clearly split among them: MFGGO, 97.2%; PS+ additional GGO, 82.1%; and PS+ PS, 41.3% (P < .001). Our results suggest that presence of a GGO component has the ability to distinguish the survival even for multiple lung cancers. Further investigations including multicenter trials are certainly warranted to address the revision of T variable of multiple lung cancers considering a presence of GGO component.

MA10.05 Proposals for the Novel Clinical T Categories Based on the Presence of Ground Glass Opacity Component in Lung Adenocarcinoma

In lung adenocarcinomas, the histologic lepidic growth pattern tends to correlate with the ground glass opacity (GGO) component, while solid components correspond with invasive adenocarcinoma. The Eighth edition of the TNM staging system suggests that the tumor size be determined according to the invasive size excluding the lepidic component. However, this new concept causes fatal confusion, i.e., tumors are classified into a same T category despite the part-solid or pure-solid appearances provided they showed a same solid component size. Between 2008 and 2012, we retrospectively evaluated 719 surgically resected cN0 lung adenocarcinomas that measures 30mm or less in total dimension to assess the prognostic impact on the presence of GGO among the Eighth TNM classification. According to the new T category, it was defined based on the solid component size as follow: Tis; 0 cm (pure-GGO), T1mi; ≤ 5 mm, T1a; 6-10 mm, T1b; 11-20 mm, T1c; 21-30mm. Furthermore, all tumors were classified into 2 groups, i.e., GGO or Solid arms based on the presence of GGO component. Of the cases, 133 (18%) were categorized in Tis, 88 (12%) in T1mi, 121 (17%) in T1a, 244 (34%) in T1b and 133 (19%) in T1c, respectively. Multivariate analysis revealed that both a presence of GGO and solid component were independently significant prognostic factors (p=0.007, 0.002). The 5y-overall survival (OS) was 99.2% in Tis, 95.8% in T1mi, 96.5% in T1a, 81.8% in T1b and 66.4% in T1c (p=0.038) with a median follow-up period of 56 months. When we evaluated the impact of T category based on GGO presence, the 5y-OS was significantly different between GGO and Solid arm in each T categories (T1a; 99.0% vs. 95.7%, p=0.045, T1b; 89.8% vs. 73.3%, p=0.004, T1c; 90.0% vs. 62.6%, p=0.046). Furthermore, clinical T categories significantly separated the OS in Solid arm (p=0.015) (T1a vs. T1b; p=0.090, T1b vs. T1c; p=0.037). In contrast, the 5y-OS was approximately 90% or more in GGO arm despite their T categories. Moreover, regarding radiological and pathological correlations, the rates of AIS was only 65% in Tis, and 51% showed invasive adenocarcinoma even in T1mi. Clinical T category should be considered based on the presence of GGO on thin-section CT, and tumor size should be applied exclusively to radiological solid lung cancer. In contrast, oncological outcomes of the tumor with GGO component were excellent despite their T categories, which should be described as Tis for pure-GGO, and T1a for part-solid tumor.