Watanabe Yukio, Hattori Aritoshi, Nojiri Shuko, Matsunaga Takeshi, Takamochi Kazuya, Oh Shiaki, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2022 Mar;163(3):791-801.e4. doi: 10.1016/j.jtcvs.2020.12.089. Epub 2020 Dec 29.
Non-small cell lung cancers with a ground-glass opacity component have better prognosis than those with solid nodules of equivalent consolidation size. However, the impact of small ground-glass opacity components on prognosis is unknown. Therefore, we aimed to evaluate the significance of a small ground-glass opacity component in solid-dominant clinical stage IA non-small cell lung cancers.
We reviewed the cases of 543 surgically resected solid-dominant c-stage IA non-small cell lung cancers, which was defined as a tumor with consolidation tumor ratio of 0.75 or more on computed tomography. The patients were classified into 2 groups: 0.75 or less consolidation tumor ratio less than 1 (n = 126) and consolidation tumor ratio of 1 (n = 417). The prognoses were compared between the 2 groups.
Among the 543 cases, multivariable analyses revealed that pure-solid appearance was a predictor of worse overall survival (hazard ratio, 2.051; 95% confidence interval, 1.044-4.028). Compared with the part-solid group, the pure-solid group was associated with poor survival in c-stages IA2 (5-year overall survival: 91.5% vs 76.8%, hazard ratio, 2.942; 95% confidence interval, 1.402-6.173; recurrence-free survival: 89.0% vs 68.8%, hazard ratio, 3.439; 95% confidence interval, 1.776-6.669) and IA3 (5-year overall survival: 93.5% vs 63.0%, hazard ratio, 5.110; 95% confidence interval, 1.607-16.241; recurrence-free survival: 80.5% vs 54.1%, hazard ratio, 2.789; 95% confidence interval, 1.290-6.027). The T categories significantly affected 5-year overall survival only in the pure-solid group (cT1a, 89.3%; cT1b, 76.8%; cT1c, 63.0%).
A small ground-glass opacity component has an impact on the prognosis of patients with solid-dominant c-stage IA non-small cell lung cancer. Therefore, c-stage IA non-small cell lung cancers should be evaluated separately for tumors with ground-glass opacity and pure-solid tumors.
具有磨玻璃密度成分的非小细胞肺癌比具有相同实性结节大小的实性结节患者预后更好。然而，小磨玻璃密度成分对预后的影响尚不清楚。因此，我们旨在评估小磨玻璃密度成分在实性为主的临床ⅠA期非小细胞肺癌中的意义。
我们回顾了543例接受手术切除的实性为主的c期ⅠA非小细胞肺癌病例，其定义为计算机断层扫描上实性肿瘤比例为0.75或更高的肿瘤。患者分为两组：实性肿瘤比例小于1且为0.75或更低（n = 126）和实性肿瘤比例为1（n = 417）。比较两组的预后。
在543例病例中，多变量分析显示纯实性表现是总生存期较差的预测因素（风险比，2.051；95%置信区间，1.044 - 4.028）。与部分实性组相比，纯实性组在c期ⅠA2（5年总生存率：91.5%对76.8%，风险比，2.942；95%置信区间，1.402 - 6.173；无复发生存率：89.0%对68.8%，风险比，3.439；95%置信区间，1.776 - 6.669）和ⅠA3期（5年总生存率：93.5%对63.0%，风险比，5.110；95%置信区间，1.607 - 16.241；无复发生存率：80.5%对54.1%，风险比，2.789；95%置信区间，1.290 - 6.027）的生存率较差。T分类仅在纯实性组中显著影响5年总生存率（cT1a，89.3%；cT1b，76.8%；cT1c，63.0%）。
小磨玻璃密度成分对实性为主的c期ⅠA非小细胞肺癌患者的预后有影响。因此，对于具有磨玻璃密度的肿瘤和纯实性肿瘤，c期ⅠA非小细胞肺癌应分别进行评估。
