Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Ann Thorac Surg. 2020 May;109(5):1530-1536. doi: 10.1016/j.athoracsur.2019.12.008. Epub 2020 Jan 22.
The prognosis of patients with cT1N0 lung adenocarcinoma is better when tumors include mixed ground glass opacity (GGO), compared with pure solid tumors. However, whether the prognosis of patients with mixed GGO tumors is favorable regardless of the solid component size remains unknown. Therefore, we aimed to determine the prognostic role of the solid component size in mixed GGO.
We retrospectively analyzed the clinicopathological findings and prognoses of 856 patients with mixed GGO tumors based on solid component size during a median follow-up of 45 months, among 1215 patients with cT1N0 lung adenocarcinoma according to the TNM Classification of Malignant Tumors, Eighth Edition, who underwent R0 resection at 3 institutions between 2010 and 2015.
Four-year recurrence-free survival rates were significantly worse for patients with mixed GGO cT1c tumors (solid component size: 2-3 cm; 81.5%; 95% confidence interval [CI], 72.8%-87.7%) than for those with cT1mi+1a tumors (0-1 cm; 96.8%; 95% CI, 94.2%-98.2%) and cT1b (1-2 cm; 95.3%; 95% CI, 92.1%-97.2%) (both P < .001), although that for cT1b tumors was comparably favorable to those of T1mi+1a tumors. Multivariable Cox regression analysis of recurrence-free survival revealed that a solid component size of 2 cm to 3 cm (cT1c) vs less than or equal to 2 cm (cT1mi+1a+1b) was an independent prognostic factor (hazard ratio, 4.16; 95% CI, 2.24-7.72; P < .001).
The prognostic impact of a solid component size less than or equal to 2 cm and greater than 2 cm significantly differs after complete resection of GGO-mixed T1N0 lung adenocarcinoma. The prognosis of patients with solid components less than or equal to 2 cm is favorable, whereas the behavior of those solid components greater than 2 cm is more aggressive.
与纯实性肿瘤相比，包含混合磨玻璃密度（GGO）的 cT1N0 肺腺癌患者的预后更好。然而，混合 GGO 肿瘤患者的预后是否无论实性成分大小均良好仍不清楚。因此，我们旨在确定混合 GGO 中实性成分大小的预后作用。
我们回顾性分析了根据第八版 TNM 恶性肿瘤分类，在 2010 年至 2015 年间在 3 家机构接受 R0 切除手术的 1215 例 cT1N0 肺腺癌患者中，856 例混合 GGO 肿瘤患者的临床病理发现和预后，这些患者的肿瘤根据实性成分大小分为 cT1c（2-3cm）、cT1mi+1a（0-1cm）和 cT1b（1-2cm）。
与 cT1mi+1a 肿瘤（0-1cm；96.8%；95%置信区间[CI]，94.2%-98.2%）和 cT1b 肿瘤（1-2cm；95.3%；95%CI，92.1%-97.2%）相比，cT1c（2-3cm）肿瘤患者的 4 年无复发生存率显著更差（均 P<0.001），尽管 cT1b 肿瘤患者的无复发生存率与 cT1mi+1a 肿瘤患者相当。无复发生存的多变量 Cox 回归分析显示，2cm 至 3cm 的实性成分大小（cT1c）与小于或等于 2cm（cT1mi+1a+1b）是独立的预后因素（风险比，4.16；95%CI，2.24-7.72；P<0.001）。
完全切除 GGO 混合 T1N0 肺腺癌后，小于或等于 2cm 和大于 2cm 的实性成分大小的预后影响显著不同。实性成分小于或等于 2cm 的患者预后良好，而实性成分大于 2cm 的患者行为更具侵袭性。
