Department of Radiology, Shanghai General Hospital (South Branch), Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Rd, Shanghai, 201600, China.
Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
AJR Am J Roentgenol. 2024 Aug;223(2):e2431283. doi: 10.2214/AJR.24.31283. Epub 2024 May 29.
The presence of a ground-glass opacity (GGO) component is a favorable prognostic factor in non-small cell lung cancer (NSCLC), although the prognostic impact of a very small GGO component remains poorly investigated. The purpose of this article is to investigate the impact of a minor (≤ 10%) GGO component on the prognosis of clinical stage I NSCLC in comparison with pure-solid nodules. This retrospective study included 382 patients (mean age, 60.8 years; 210 men, 172 women) who underwent surgical resection between January 1, 2015, and December 31, 2015, for clinical stage I NSCLC appearing on preoperative chest CT as a nodule with a consolidation-to-tumor ratio (CTR) of 0.9 to 1.0. Two radiologists independently assigned nodules to groups as either minor GGO (CTR, ≥ 0.9 and < 1.0) or pure solid (CTR = 1.0). Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed by Kaplan-Meier curves and compared between groups using log-rank tests. Cox proportional hazards models were used to assess associations with outcomes. The two radiologists agreed for all nodules' classification into the minor-GGO ( = 106) or pure-solid ( = 276) groups. The mean CTR of the minor-GGO group was 0.93 ± 0.02 (SD) (range, 0.90-0.97). Minor-GGO nodules, in comparison with pure-solid nodules, showed greater solid-component diameter (2.68 vs 2.16 cm; < .001) and total nodule diameter (2.89 vs 2.16 cm; < .001). The minor-GGO group, in comparison with the pure-solid group, showed lower frequencies of visceral pleural invasion (6.6% vs 17.0%, = .009) and pathologic lymph node involvement (4.7% vs 20.3%, < .001), and mutation (71.6% vs 39.9%; < .001). The minor-GGO group, in comparison with the pure-solid group, showed better 5-year RFS (83.4% vs 55.0%; < .001) and higher frequency of better 5-year CSS (92.4% vs 76.4%, = .004). In multivariable analysis adjusting for patient, imaging, pathologic, and genetic factors, a minor-GGO component was independently associated with a decreased likelihood of recurrence (HR = 0.37, = .001) but not with the likelihood of CSS. Among patients with clinical stage I NSCLC, cancers with a minor-GGO component were associated with a better prognosis versus those with a pure-solid appearance. Radiologists encountering predominantly solid nodules on CT should carefully assess images for even a minor-GGO component given the favorable prognosis.
磨玻璃密度（GGO）成分的存在是非小细胞肺癌（NSCLC）的一个有利预后因素，尽管 GGO 成分非常小的预后影响仍未得到很好的研究。本文的目的是研究在临床 I 期 NSCLC 中，与纯实性结节相比，少量（≤10%）GGO 成分对预后的影响。这项回顾性研究纳入了 382 名患者（平均年龄 60.8 岁；210 名男性，172 名女性），他们于 2015 年 1 月 1 日至 2015 年 12 月 31 日因术前胸部 CT 显示为实性肿瘤比（CTR）为 0.9 至 1.0 的结节而接受了手术切除，临床 I 期 NSCLC。两名放射科医生独立地将结节分为两组：小 GGO（CTR，≥0.9 且 <1.0）或纯实性（CTR = 1.0）。通过 Kaplan-Meier 曲线评估无复发生存（RFS）和癌症特异性生存（CSS），并使用对数秩检验比较组间差异。Cox 比例风险模型用于评估与结果的相关性。两名放射科医生均同意将所有结节的分类为小 GGO（ = 106）或纯实性（ = 276）组。小 GGO 组的平均 CTR 为 0.93 ± 0.02（标准差）（范围，0.90-0.97）。与纯实性结节相比，小 GGO 结节的实性成分直径（2.68 比 2.16 cm；<.001）和总结节直径（2.89 比 2.16 cm；<.001）更大。与纯实性组相比，小 GGO 组的脏层胸膜侵犯频率较低（6.6%比 17.0%； =.009）和病理淋巴结受累频率较低（4.7%比 20.3%；<.001），以及 突变频率较高（71.6%比 39.9%；<.001）。与纯实性组相比，小 GGO 组的 5 年 RFS 更好（83.4%比 55.0%；<.001），且 5 年 CSS 更好的频率更高（92.4%比 76.4%； =.004）。在调整患者、影像学、病理学和遗传学因素的多变量分析中，小 GGO 成分与复发可能性降低独立相关（HR = 0.37，.001），但与 CSS 可能性无关。在临床 I 期 NSCLC 患者中，与纯实性外观相比，具有小 GGO 成分的癌症与更好的预后相关。放射科医生在 CT 上遇到主要为实性结节时，应仔细评估图像，即使存在小 GGO 成分，也应考虑到有利的预后。
