Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
Eur Radiol. 2024 Mar;34(3):1905-1920. doi: 10.1007/s00330-023-10160-x. Epub 2023 Aug 31.
The prognostic value of ground-glass opacity at preoperative chest CT scans in early-stage lung adenocarcinomas is a matter of debate. We aimed to clarify the existing evidence through a single-center, retrospective cohort study and to quantitatively summarize the body of literature by conducting a meta-analysis.
In a retrospective cohort study, patients with clinical stage I lung adenocarcinoma were identified, and the prognostic value of ground-glass opacity was analyzed using multivariable Cox regression. Commercial artificial intelligence software was adopted as the second reader for the presence of ground-glass opacity. The primary end points were freedom from recurrence (FFR) and lung cancer-specific survival (LCSS). In a meta-analysis, we systematically searched Embase and OVID-MEDLINE up to December 30, 2021, for the studies based on the eighth-edition staging system. The pooled hazard ratios (HRs) of solid nodules (i.e., absence of ground-glass opacity) for various end points were calculated with a multi-level random effects model.
In a cohort of 612 patients, solid nodules were associated with worse outcomes for FFR (adjusted HR, 1.98; 95% CI: 1.17-3.51; p = 0.01) and LCSS (adjusted HR, 1.937; 95% CI: 1.002-4.065; p = 0.049). The artificial intelligence assessment and multiple sensitivity analyses revealed consistent results. The meta-analysis included 13 studies with 12,080 patients. The pooled HR of solid nodules was 2.13 (95% CI: 1.69-2.67; I = 30.4%) for overall survival, 2.45 (95% CI: 1.52-3.95; I = 0.0%) for FFR, and 2.50 (95% CI: 1.28-4.91; I = 30.6%) for recurrence-free survival.
The absence of ground-glass opacity in early-stage lung adenocarcinomas is associated with worse postoperative survival.
Early-stage lung adenocarcinomas manifesting as solid nodules at preoperative chest CT, which indicates the absence of ground-glass opacity, were associated with poor postoperative survival. There is room for improvement of the clinical T categorization in the next edition staging system.
• In a retrospective study of 612 patients with stage I lung adenocarcinoma, solid nodules were associated with shorter freedom from recurrence (adjusted hazard ratio [HR], 1.98; p = 0.01) and lung cancer-specific survival (adjusted HR, 1.937; p = 0.049). • Artificial intelligence-assessed solid nodules also showed worse prognosis (adjusted HR for freedom from recurrence, 1.94 [p = 0.01]; adjusted HR for lung cancer-specific survival, 1.93 [p = 0.04]). • In meta-analyses, the solid nodules were associated with shorter freedom from recurrence (HR, 2.45) and shorter overall survival (HR, 2.13).
术前胸部 CT 扫描中磨玻璃密度影对早期肺腺癌的预后价值存在争议。我们旨在通过单中心回顾性队列研究阐明现有证据，并通过荟萃分析定量总结文献。
在回顾性队列研究中，确定了临床 I 期肺腺癌患者，并使用多变量 Cox 回归分析磨玻璃密度影的预后价值。商业人工智能软件被用作磨玻璃密度的第二读者。主要终点是无复发生存率（FFR）和肺癌特异性生存率（LCSS）。在荟萃分析中，我们系统地检索了 Embase 和 OVID-MEDLINE，以获取基于第八版分期系统的研究。使用多级随机效应模型计算实性结节（即无磨玻璃密度影）的各终点的合并危险比（HR）。
在 612 例患者的队列中，实性结节与 FFR（调整 HR，1.98；95%CI：1.17-3.51；p=0.01）和 LCSS（调整 HR，1.937；95%CI：1.002-4.065；p=0.049）的预后较差有关。人工智能评估和多次敏感性分析显示出一致的结果。荟萃分析纳入了 13 项研究，共 12080 例患者。实性结节的汇总 HR 为总生存 2.13（95%CI：1.69-2.67；I=30.4%），FFR 为 2.45（95%CI：1.52-3.95；I=0.0%），无复发生存率为 2.50（95%CI：1.28-4.91；I=30.6%）。
早期肺腺癌在术前胸部 CT 上表现为实性结节，提示无磨玻璃密度影，与术后生存不良有关。在下一版分期系统中，临床 T 分类有改进的空间。
术前胸部 CT 显示的早期肺腺癌实性结节，提示无磨玻璃密度影，与术后生存不良相关。
