伴有淋巴结转移的肺腺癌切除术：磨玻璃密度成分是一个预后因素吗？
Resected lung adenocarcinoma with lymph node metastasis: is ground glass opacity component a prognostic factor?
作者信息
Deng Chaoqiang, Jiang Chenyu, Ma Xiangyi, Fu Fangqiu, Wang Shengping, Li Yuan, Zhang Yang, Chen Haiquan
机构信息
Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
Institute of Thoracic Oncology, Fudan University, Shanghai, China.
出版信息
Transl Lung Cancer Res. 2024 Jul 30;13(7):1609-1619. doi: 10.21037/tlcr-24-170. Epub 2024 Jul 25.
BACKGROUND
Ground glass opacity (GGO)-featured lung adenocarcinoma generally has excellent prognosis, and here is rarely the occurrence of lymph node metastasis. We conducted a retrospective cohort study to explore the prognostic impact of GGO component in node-positive lung adenocarcinomas.
METHODS
A total of 669 patients with pathologic N1/N2 lung adenocarcinoma receiving R0 resection and systemic lymph node dissection from 2008 to 2015 were reviewed, including 635 solid and 34 part-solid lesions. Propensity score matching (PSM) was performed to compare survival outcomes of solid and part-solid lesions, in order to determine the prognostic value of GGO component. Cox proportional hazard model was performed to identify significant prognostic factors for resected node positive lung adenocarcinoma.
RESULTS
About 5.1% (34 of 669) of resected node-positive lung adenocarcinoma presented as part-solid nodules on computed tomography (CT) images in this cohort. The median nodule size on CT of the 34 part-solid lesions was 31 mm (range, 15-68 mm), median solid component size on CT was 24 mm (range, 12-62 mm), and median consolidation/tumor ratio was 0.8 (range, 0.64-0.95). After 1:4 PSM, 136 patients and 34 patients were matched from the solid and part-solid groups. No significant difference in either recurrence-free survival (RFS) (P=0.71) or overall survival (OS) (P=0.82) was found between the solid and part-solid groups. Multivariable Cox regression showed that pN stage was the strongest prognostic factor for RFS and OS. GGO component was not an independent prognostic factor toward for RFS [P=0.75; hazard ratio (HR) =0.93; 95% confidence interval (CI): 0.59-1.46] or OS (P=0.53; HR =1.19; 95% CI: 0.69-2.05).
CONCLUSIONS
A minority of resected node-positive lung adenocarcinoma presents as GGO component on CT. The presence of GGO component does not predict better prognosis in node-positive lung adenocarcinoma.
背景
磨玻璃影（GGO）特征性肺腺癌通常预后良好，很少发生淋巴结转移。我们进行了一项回顾性队列研究，以探讨GGO成分对淋巴结阳性肺腺癌预后的影响。
方法
回顾性分析2008年至2015年期间接受R0切除和系统性淋巴结清扫的669例病理N1/N2期肺腺癌患者，其中包括635例实性病变和34例部分实性病变。采用倾向评分匹配（PSM）比较实性和部分实性病变的生存结局，以确定GGO成分的预后价值。采用Cox比例风险模型确定切除的淋巴结阳性肺腺癌的显著预后因素。
结果
在该队列中，约5.1%（669例中的34例）切除的淋巴结阳性肺腺癌在计算机断层扫描（CT）图像上表现为部分实性结节。34例部分实性病变的CT上结节中位大小为31mm（范围15 - 68mm），CT上实性成分中位大小为24mm（范围12 - 62mm），中位实变/肿瘤比值为0.8（范围0.64 - 0.95）。经过1:4的PSM后，从实性组和部分实性组中分别匹配了136例和34例患者。实性组和部分实性组之间在无复发生存期（RFS）（P = 0.71）或总生存期（OS）（P = 0.82）方面均未发现显著差异。多变量Cox回归显示，pN分期是RFS和OS最强的预后因素。GGO成分不是RFS [P = 0.75；风险比（HR）= 0.93；95%置信区间（CI）：0.59 - 1.46]或OS（P = 0.53；HR = 1.19；95% CI：0.69 - 2.05）的独立预后因素。
结论
少数切除的淋巴结阳性肺腺癌在CT上表现为GGO成分。GGO成分的存在并不能预测淋巴结阳性肺腺癌的更好预后。
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