Kodama K, Higashiyama M, Yokouchi H, Takami K, Kuriyama K, Mano M, Nakayama T
Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
Lung Cancer. 2001 Jul;33(1):17-25. doi: 10.1016/s0169-5002(01)00185-4.
This study was undertaken to investigate the value of the ground-glass opacity (GGO) area found on high-resolution computed tomography (HRCT) scanning as a preoperative prognostic indicator.
We studied 104 patients with small-sized lung adenocarcinoma, 20 mm or less in diameter, between 1995 and 1999. Three independent radiologists semi-quantitatively scored the extent of GGO on HRCT as greater than or less than 50%. Three independent pathologists semi-quantitatively scored the extent of the bronchioloalveolar carcinoma (BAC) component of the tumor on histologic examination as greater than or less than 50%. As no relapse occurred in patients with GGO greater than 50%, multivariate analysis of this prognostic factor was not possible.
Fifty patients were scored as having both BAC and GGO greater than 50%, 36 as both BAC and GGO less than 50%, and 16 as BAC greater than 50% and GGO less than 50%. In only two patients (1.9%), BAC less than 50% was overestimated on HRCT as GGO greater than 50%. The sensitivity and specificity of GGO to BAC were 76 and 95%, respectively. The 3 year-relapse-free survival rates in each group of 52 patients with GGO greater than and less than 50% were 100 and 72%, respectively, after a median follow-up of 24 months. Univariate analysis indicated that both GGO and BAC areas were significantly correlated with cancer relapse (P=0.005 and P=0.002). The multivariate analysis revealed an independent prognostic influence of the BAC area on relapse-free survival (P=0.015, relative risk=0.07).
To date there has been no relapse among the 52 patients with GGO greater than 50%. This novel classification based on the semiquantitative analysis of GGO area on HRCT should become an useful independent preoperative indicator when deciding on operative procedure, and to predict the potential of relapse in patients with small adenocarcinoma arising from the peripheral lung.
本研究旨在探讨高分辨率计算机断层扫描（HRCT）上发现的磨玻璃影（GGO）面积作为术前预后指标的价值。
我们研究了1995年至1999年间104例直径20mm或更小的小尺寸肺腺癌患者。三名独立的放射科医生对HRCT上GGO的范围进行半定量评分，分为大于或小于50%。三名独立的病理科医生对肿瘤组织学检查中细支气管肺泡癌（BAC）成分的范围进行半定量评分，分为大于或小于50%。由于GGO大于50%的患者未发生复发，因此无法对该预后因素进行多因素分析。
50例患者的BAC和GGO均大于50%，36例患者的BAC和GGO均小于50%，16例患者的BAC大于50%而GGO小于50%。仅2例患者（1.9%）HRCT上BAC小于50%被高估为GGO大于50%。GGO对BAC的敏感性和特异性分别为76%和95%。在中位随访24个月后，GGO大于和小于50%的两组各52例患者的3年无复发生存率分别为100%和72%。单因素分析表明GGO和BAC面积均与癌症复发显著相关（P=0.005和P=0.002）。多因素分析显示BAC面积对无复发生存有独立的预后影响（P=0.015，相对风险=0.07）。
迄今为止，52例GGO大于50%的患者均未复发。这种基于HRCT上GGO面积半定量分析的新分类方法在决定手术方式时应成为一个有用的独立术前指标，并可预测周围型小腺癌患者的复发可能性。
