Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Clin Lung Cancer. 2018 Sep;19(5):e609-e617. doi: 10.1016/j.cllc.2018.04.020. Epub 2018 May 5.
In this study we aimed to identify the risk factors of recurrence in patients with clinical stage IA adenocarcinoma presented as ground glass nodule (GGN) on computed tomography scans.
The study included 245 patients with clinical stage IA adenocarcinoma presented as GGN who underwent surgery during 2010 to 2013. All patients were divided into 2 subgroups on the basis of consolidation diameter to tumor diameter (C/T) ratio on lung window: (1) ground-glass opacity (GGO)-dominant subgroup (C/T ≤ 0.5; n = 179); (2) solid-dominant subgroup (C/T > 0.5; n = 66). Recurrence-free survival (RFS) was analyzed to identify independent risk factors of recurrence using the Kaplan-Meier approach and multivariable Cox models.
Patients in the GGO-dominant subgroup had a better prognosis than those in the solid-dominant subgroup (5-year RFS: 98% vs. 87%; P < .001). Multivariate analysis confirmed that C/T ratio was an independent risk factor for RFS in patients with clinical stage IA adenocarcinoma presented as GGN (hazard ratio [HR], 9.47; 95% confidence interval [CI], 1.75-51.1; P = .009). In the analysis of the solid-dominant group, multivariate analysis showed that limited resection was an independent risk factor of recurrence in this subgroup (HR, 6.86; 95% CI, 1.50-31.42; P = .013). Regarding the GGO-dominant subgroup, surgical type was not a risk factor of recurrence.
Patients with clinical stage IA solid-dominant adenocarcinoma (C/T ratio > 0.5) had a higher rate of recurrence after limited resection than lobectomy. Thus, limited resection should be performed cautiously in these patients (C/T ratio > 0.5).
本研究旨在确定在计算机断层扫描（CT）扫描表现为磨玻璃结节（GGN）的临床ⅠA 期腺癌患者中，复发的危险因素。
该研究纳入了 2010 年至 2013 年间接受手术的 245 例临床ⅠA 期腺癌伴 GGN 患者。所有患者均根据肺窗上的实变直径与肿瘤直径（C/T）比值分为 2 个亚组：（1）磨玻璃密度（GGO）为主亚组（C/T≤0.5；n=179）；（2）实性为主亚组（C/T＞0.5；n=66）。采用 Kaplan-Meier 法和多变量 Cox 模型分析无复发生存率（RFS），以确定复发的独立危险因素。
GGO 为主亚组患者的预后优于实性为主亚组（5 年 RFS：98% vs. 87%；P＜0.001）。多变量分析证实，在 CT 扫描表现为 GGN 的临床ⅠA 期腺癌患者中，C/T 比值是 RFS 的独立危险因素（危险比 [HR]，9.47；95%置信区间 [CI]，1.75-51.1；P=0.009）。在实性为主亚组的分析中，多变量分析显示，局限性切除是该亚组复发的独立危险因素（HR，6.86；95% CI，1.50-31.42；P=0.013）。对于 GGO 为主亚组，手术类型不是复发的危险因素。
在接受局限性切除的临床ⅠA 期腺癌（C/T 比值＞0.5）患者中，实性为主的患者复发率高于行肺叶切除术的患者。因此，对于 C/T 比值＞0.5 的这些患者，应谨慎行局限性切除。
