Hamada Akira, Suda Kenichi, Fujino Toshio, Nishino Masaya, Ohara Shuta, Koga Takamasa, Kabasawa Takanobu, Chiba Masato, Shimoji Masaki, Endoh Makoto, Takemoto Toshiki, Soh Junichi, Yanagawa Naoki, Shiono Satoshi, Mitsudomi Tetsuya
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Pathological Diagnostics, Faculty of Medicine, Yamagata University, Yamagata, Japan.
JTO Clin Res Rep. 2022 Apr 6;3(5):100321. doi: 10.1016/j.jtocrr.2022.100321. eCollection 2022 May.
Recent studies have suggested that including presence or absence of ground-glass opacity (GGO) may improve the tumor descriptor (T descriptor) classification in clinical stage I NSCLC. In this study, we analyzed prognostic implications of presence or absence of GGO, size of the solid component, and predominant histology to identify the true prognostic determinant for early-stage NSCLC.
We retrospectively examined 384 patients with clinical stage I NSCLC (solid: 242, part solid: 142) who underwent complete resection between 2009 and 2013.
Survival curves of the whole cohort revealed good separation using the current TNM classification. Nevertheless, the part-solid group had a favorable prognosis irrespective of solid component size. Conversely, patients in the solid tumor group with tumors between 3 and 4 cm had a worse prognosis than patients whose tumors were less than or equal to 3 cm. Thus, we propose the following novel T descriptor classification: IA, part-solid tumors; IB, solid tumors less than or equal to 3 cm; and IC, solid tumors between 3 and 4 cm. This novel classification system stratified patient prognosis better than the current classification. On pathologic evaluation, the part-solid group always had better prognoses than the solid group in each subgroup divided by pathologic grade.
These results suggest that presence of GGO is the true prognostic determinant of stage I NSCLC, irrespective of the size of the solid component. Our novel T descriptor classification system could more accurately predict prognoses of clinical stage I NSCLC cases.
近期研究表明，纳入磨玻璃影（GGO）的有无可能改善临床I期非小细胞肺癌（NSCLC）的肿瘤描述符（T描述符）分类。在本研究中，我们分析了GGO的有无、实性成分大小和主要组织学类型对预后的影响，以确定早期NSCLC真正的预后决定因素。
我们回顾性研究了2009年至2013年间接受根治性切除的384例临床I期NSCLC患者（实性：242例，部分实性：142例）。
整个队列的生存曲线显示，使用当前的TNM分类有良好的区分度。然而，部分实性组无论实性成分大小，预后均较好。相反，实性肿瘤组中肿瘤大小在3至4 cm之间的患者比肿瘤小于或等于3 cm的患者预后更差。因此，我们提出以下新的T描述符分类：IA，部分实性肿瘤；IB，实性肿瘤小于或等于3 cm；IC，实性肿瘤在3至4 cm之间。这种新的分类系统比当前分类能更好地分层患者预后。在病理评估中，在按病理分级划分的每个亚组中，部分实性组的预后总是优于实性组。
这些结果表明，GGO的存在是I期NSCLC真正的预后决定因素，与实性成分大小无关。我们新的T描述符分类系统可以更准确地预测临床I期NSCLC病例的预后。
