Department of Thoracic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China.
J Thorac Oncol. 2019 Apr;14(4):617-627. doi: 10.1016/j.jtho.2018.12.030. Epub 2019 Jan 17.
The clinicopathologic features and prognostic predictors of radiological part-solid lung adenocarcinomas were unclear.
We retrospectively compared the clinicopathologic features and survival times of part-solid tumors with those of pure ground glass nodules (pGGNs) and pure solid tumors treated with surgery at Fudan University Shanghai Cancer Center and evaluated the prognostic implications of consolidation-to-tumor ratio (CTR), solid component size, and tumor size for part-solid lung adenocarcinomas.
A total of 911 patients and 988 pulmonary nodules (including 329 part-solid nodules [PSNs], 501 pGGNs, and 158 pure solid nodules) were analyzed. More female patients (p = 0.015) and nonsmokers (p = 0.003) were seen with PSNs than with pure solid nodules. The prevalence of lymphatic metastasis was lower in patients with PSNs than in those with pure solid tumors (2.2% versus 27% [p < 0.001]). The 5-year lung cancer-specific (LCS) recurrence-free survival and LCS overall survival of patients with PSNs were worse than those of patients with pGGNs (p < 0.001 and p = .042, respectively) but better than those of patients with pure solid tumors ([p < 0.001 and p < 0.0001, respectively]). CTR (OR = 12.90; 95% confidence interval [CI]: 1.85-90.04), solid component size (OR = 1.45; 95% CI: 1.28-1.64), and tumor size (OR = 1.23; 95% CI: 1.15-1.31) could predict pathologic invasive adenocarcinoma for patients with PSNs. None of them could predict the prognosis. Patients receiving sublobar resection had prognoses comparable to those of patients receiving lobectomy (p = .178 for 5-year LCS recurrence-free survival and p = .319 for 5-year LCS overall survival). The prognostic differences between patients with systemic lymph node dissection and those without systemic lymph node dissection were statistically insignificant.
Part-solid lung adenocarcinoma showed clinicopathologic features different from those of pure solid tumor. CTR, solid component size, and tumor size could not predict the prognosis. Part-solid lung adenocarcinomas define one special clinical subtype.
影像学部分实性肺腺癌的临床病理特征和预后预测因素尚不清楚。
我们回顾性比较了复旦大学附属肿瘤医院手术治疗的部分实性肿瘤与纯磨玻璃结节（pGGN）和纯实性肿瘤的临床病理特征和生存时间，并评估了实变与肿瘤比值（CTR）、实性成分大小和肿瘤大小对部分实性肺腺癌的预后意义。
共分析了 911 名患者和 988 个肺部结节（包括 329 个部分实性结节[PSN]、501 个 pGGN 和 158 个纯实性结节）。与纯实性结节相比，PSN 患者中女性（p=0.015）和不吸烟者（p=0.003）更多。PSN 患者的淋巴转移发生率低于纯实性肿瘤患者（2.2%比 27%[p<0.001]）。PSN 患者的 5 年肺癌特异性（LCS）无复发生存率和 LCS 总生存率均低于 pGGN 患者（p<0.001 和 p=0.042），但优于纯实性肿瘤患者（[p<0.001 和 p<0.0001]）。CTR（OR=12.90；95%置信区间[CI]：1.85-90.04）、实性成分大小（OR=1.45；95%CI：1.28-1.64）和肿瘤大小（OR=1.23；95%CI：1.15-1.31）可预测 PSN 患者的病理浸润性腺癌。但没有任何因素可以预测预后。接受亚肺叶切除术的患者与接受肺叶切除术的患者预后相当（p=0.178 时为 5 年 LCS 无复发生存率，p=0.319 时为 5 年 LCS 总生存率）。接受系统性淋巴结清扫术与未接受系统性淋巴结清扫术的患者之间的预后差异无统计学意义。
部分实性肺腺癌具有不同于纯实性肿瘤的临床病理特征。CTR、实性成分大小和肿瘤大小不能预测预后。部分实性肺腺癌定义为一种特殊的临床亚型。
