Predictors of Pathologic Tumor Invasion and Prognosis for Ground Glass Opacity Featured Lung Adenocarcinoma.

BACKGROUND We make surgical strategies for ground glass opacity (GGO) nodules currently based on thin-section (TS) computed tomography (CT) findings. Whether radiologic measurements could precisely predict tumor invasion and prognosis of GGO-featured lung adenocarcinoma is uncertain. METHODS We retrospectively evaluated medical records of patients with radiologic GGO nodules undergoing a surgical procedure at Fudan University Shanghai Cancer Center. The study endpoints were the predictive value and prognostic significance of radiologic measurements (consolidation-to-tumor ratio value, consolidation size, and tumor size) for pathologic lung adenocarcinoma. RESULTS In this study 736 patients and 841 GGO nodules were included. Five-year lung cancer-specific regression-free survival (LCS-RFS) rate was 95.76% (95% confidence interval [CI], 93.01% to 97.44%). The 5-year LCS overall survival (OS) rate was 98.99% (95% CI, 97.69% to 99.57%). Multivariable analysis showed that tumor invasion (invasive adenocarcinoma [IAD] vs adenocarcinoma in situ [AIS]/minimally invasive adenocarcinoma [MIA], p = 0.020) was the only independent predictor for 5-year LCS-RFS. IAD (hazard ratio, 15.98; 95% CI, 1.55 to 164.35) was correlated with a higher risk of recurrence. Kaplan-Meier analysis showed that only tumor invasion status (IAD vs AIS/MIA, p = 0.003) could predict 5-year lung cancer-specific overall survival (LCS-OS), and IAD had a worse LCS-OS than AIS and MIA. A part-solid component (odds ratio [OR], 9.09; 95% CI, 2.71 to 30.47; p = 0.000), large consolidation size (OR, 3.11; 95% CI, 1.03 to 9.40; p = 0.045), and large tumor size (OR, 5.48; 95% CI, 2.68 to 11.19; p = 0.000) were associated with pathologic IAD. For IAD ≤ 20 mm, segmentectomy and lobectomy had better 5-year LCS-RFS than wedge resection, although the difference was statistically insignificant (p = 0.367). The three types of surgeries provided the similar 5-year LCS-OS (p = 0.834). CONCLUSIONS Radiologic measurements could not precisely predict tumor invasion and prognosis. Making treatment strategies solely according to TS-CT findings for GGO tumor is inappropriate.

[1]  C. Henschke,et al.  Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules , 2017, Annals of surgery.

[2]  K. Ashizawa,et al.  Comparison between solid component size on thin-section CT and pathologic lymph node metastasis and local invasion in T1 lung adenocarcinoma , 2017, Japanese Journal of Radiology.

[3]  R. Sugimoto,et al.  Long‐term Outcomes of Patients With Ground‐Glass Opacities Detected Using CT Scanning , 2017, Chest.

[4]  Kiyoshi Mori,et al.  Comparison of three measurements on computed tomography for the prediction of less invasiveness in patients with clinical stage I non-small cell lung cancer. , 2013, The Annals of thoracic surgery.

[5]  H. Iwata,et al.  Feasibility of segmental resection in non-small-cell lung cancer with ground-glass opacity. , 2014, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[6]  Takashi Hirai,et al.  Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters. , 2014, The Journal of thoracic and cardiovascular surgery.

[7]  C. Gatsonis,et al.  Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening , 2012 .

[8]  P. Phan,et al.  Inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules , 2015, Acta radiologica.

[9]  Kenji Suzuki,et al.  Importance of Ground Glass Opacity Component in Clinical Stage IA Radiologic Invasive Lung Cancer. , 2017, The Annals of thoracic surgery.

[10]  M. Tsuboi,et al.  Limited resection trial for pulmonary ground-glass opacity nodules: case selection based on high-resolution computed tomography-interim results. , 2015, Japanese journal of clinical oncology.

[11]  C. Berg,et al.  Targeting of low-dose CT screening according to the risk of lung-cancer death. , 2013, The New England journal of medicine.

[12]  Yang Zhang,et al.  Precise Diagnosis of Intraoperative Frozen Section Is an Effective Method to Guide Resection Strategy for Peripheral Small-Sized Lung Adenocarcinoma. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  Denis Tack,et al.  Differentiating between Subsolid and Solid Pulmonary Nodules at CT: Inter- and Intraobserver Agreement between Experienced Thoracic Radiologists. , 2016, Radiology.

[14]  K Kuriyama,et al.  Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning. , 2001, Lung cancer.

[15]  Y. Shim,et al.  Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules. , 2015, The Annals of thoracic surgery.

[16]  S. Sung,et al.  Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. , 2016, Journal of thoracic disease.

[17]  Kenji Suzuki,et al.  Limited resection for early-stage non-small cell lung cancer as function-preserving radical surgery: a review. , 2017, Japanese journal of clinical oncology.

[18]  T. Ohira,et al.  Correlation between whole tumor size and solid component size on high-resolution computed tomography in the prediction of the degree of pathologic malignancy and the prognostic outcome in primary lung adenocarcinoma , 2015, Acta radiologica.

[19]  C. Henschke,et al.  CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds. , 2015, Radiology.

[20]  M. Beasley,et al.  Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer: a pilot study. , 2014, Chest.

[21]  C. Henschke,et al.  Lung Cancers Manifesting as Part-Solid Nodules in the National Lung Screening Trial. , 2017, AJR. American journal of roentgenology.

[22]  N. Ishizuka,et al.  Relationship between the consolidation to maximum tumor diameter ratio and outcomes following stereotactic body radiotherapy for stage I non-small-cell lung cancer. , 2016, Lung cancer.

[23]  M. Okada,et al.  Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. , 2014, Chest.

[24]  Masahiko Kusumoto,et al.  Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201. , 2013, The Journal of thoracic and cardiovascular surgery.

[25]  Kenji Suzuki,et al.  A Prospective Radiological Study of Thin-Section Computed Tomography to Predict Pathological Noninvasiveness in Peripheral Clinical IA Lung Cancer (Japan Clinical Oncology Group 0201) , 2011, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[26]  M. Okada,et al.  Segmentectomy for clinical stage IA lung adenocarcinoma showing solid dominance on radiology. , 2014, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[27]  M. Okada,et al.  Prognostic value of the new IASLC/ATS/ERS classification of clinical stage IA lung adenocarcinoma. , 2015, Lung cancer.

[28]  T. Ohira,et al.  Association between high-resolution computed tomography findings and the IASLC/ATS/ERS classification of small lung adenocarcinomas in Japanese patients. , 2015, Lung cancer.

[29]  Masahiro Tsuboi,et al.  International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma , 2011, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[30]  Kenji Suzuki,et al.  Neither Maximum Tumor Size nor Solid Component Size Is Prognostic in Part-Solid Lung Cancer: Impact of Tumor Size Should Be Applied Exclusively to Solid Lung Cancer. , 2016, The Annals of thoracic surgery.

[31]  E. Halm,et al.  Limited Resection for the Treatment of Patients With Stage IA Lung Cancer , 2010, Annals of surgery.