Tamagawa Satoru, Nakao Masayuki, Oikado Katsunori, Sato Yoshinao, Hashimoto Kohei, Ichinose Junji, Matsuura Yosuke, Okumura Sakae, Satoh Yukitoshi, Mun Mingyon
Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
J Thorac Dis. 2024 May 31;16(5):2975-2982. doi: 10.21037/jtd-24-144. Epub 2024 May 15.
In early-stage non-small cell lung cancer (NSCLC), the presence of a ground-glass opacity (GGO) component in the primary lesion on high-resolution computed tomography (CT) is recognized as a favorable prognostic factor. Even in NSCLC with a GGO component, lymph node metastases are occasionally detected during or after surgery. However, the prognostic impact of GGO components in these patients has not been clarified. We aimed to examine the prognostic significance of GGO components as radiological findings of primary lesions of completely resected NSCLC with pathological nodal involvement.
This study included 290 patients (11%) with pathological nodal involvement among 2,546 patients who underwent complete resection of NSCLC at our institution. Patients with an unknown primary lesion (T0) or centrally located lung cancer were excluded. The 290 patients were divided into two groups [i.e., the part-solid ("PS") and "Solid" groups] according to the radiological findings of the primary lesion, and their clinicopathological characteristics and prognoses were compared. Furthermore, a multivariate analysis was performed using the Cox proportional hazards model to examine the factors affecting the overall survival (OS).
The OS in the PS group (n=58) was significantly longer than that in the Solid group (n=232; P=0.039). However, multivariate analysis only revealed age [hazard ratio (HR) =1.77; 95% confidence interval (CI): 1.15-2.72] and the clinical T factor (HR =1.58; 95% CI: 1.01-2.47), but not the radiological findings of primary lesions, as the independent prognostic factors. Furthermore, the OS did not differ significantly between the PS and Solid groups matched for the clinical T and N factors (n=58 patients each).
GGO components in the primary lesion, considered a decisive prognostic factor in early-stage NSCLC, did not affect the prognosis of patients with NSCLC and pathological nodal involvement.
在早期非小细胞肺癌（NSCLC）中，高分辨率计算机断层扫描（CT）显示原发性病变存在磨玻璃密度影（GGO）成分被认为是一个有利的预后因素。即使在具有GGO成分的NSCLC中，手术期间或术后偶尔也会检测到淋巴结转移。然而，这些患者中GGO成分对预后的影响尚未阐明。我们旨在研究GGO成分作为完全切除的伴有病理淋巴结受累的NSCLC原发性病变的影像学表现的预后意义。
本研究纳入了在我院接受NSCLC完全切除的2546例患者中290例（11%）有病理淋巴结受累的患者。排除原发性病变不明（T0）或中央型肺癌患者。根据原发性病变的影像学表现，将290例患者分为两组[即部分实性（“PS”）组和“实性”组]，并比较其临床病理特征和预后。此外，使用Cox比例风险模型进行多因素分析，以检查影响总生存期（OS）的因素。
PS组（n = 58）的OS明显长于实性组（n = 232；P = 0.039）。然而，多因素分析仅显示年龄[风险比（HR）= 1.77；95%置信区间（CI）：1.15 - 2.72]和临床T分期（HR = 1.58；95%CI：1.01 - 2.47），而非原发性病变的影像学表现，为独立预后因素。此外，在临床T和N分期匹配的PS组和实性组（每组n = 58例患者）之间，OS无显著差异。
原发性病变中的GGO成分，在早期NSCLC中被认为是一个决定性的预后因素，但并不影响伴有病理淋巴结受累的NSCLC患者的预后。
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