Choe Jooae, Lee Sang Min, Park Sohee, Choi Sehoon, Do Kyung-Hyun, Seo Joon Beom
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Eur Radiol. 2025 Apr;35(4):2256-2264. doi: 10.1007/s00330-024-11048-0. Epub 2024 Sep 16.
There is still a debate regarding the prognostic implication of lymphovascular invasion (LVI) in stage I lung adenocarcinoma. Ground-glass opacity (GGO) on CT is known to correlate with a less invasive or lepidic component in adenocarcinoma, which may influence the strength of prognostic factors. This study aimed to explore the prognostic value of LVI in stage I lung adenocarcinoma based on the presence of GGO.
Stage I lung adenocarcinoma patients receiving lobectomy between 2010 and 2019 were retrospectively categorized as GGO-positive or GGO-negative (solid adenocarcinoma) on CT. Multivariable Cox regression analyses were performed for disease-free survival (DFS) and overall survival (OS) to evaluate the prognostic significance of pathologic LVI based on the presence of GGO.
Of 924 patients included (mean age, 62.5 ± 9.2 years; 505 women), 525 (56.8%) exhibited GGO-positive adenocarcinoma and 116 (12.6%) were diagnosed with LVI. LVI was significantly more frequent in solid than GGO-positive adenocarcinoma (20.1% vs. 6.9%, p < 0.001). Multivariable analysis identified LVI and visceral pleural invasion (VPI) as significant prognostic factors for shorter DFS among solid adenocarcinoma patients (LVI, hazard ratio (HR): 1.89, p = 0.004; VPI, HR: 1.65, p = 0.003) but not GGO-positive patients (p = 0.76 and p = 0.87). In contrast, LVI was not a significant prognostic factor for OS in either group (p > 0.05).
In stage I lung adenocarcinoma, pathologic LVI was associated with DFS only in patients with solid lung adenocarcinoma.
Lymphovascular invasion (LVI) significantly affects disease-free survival in solid-stage I lung adenocarcinoma patients, but not those with ground-glass opacity (GGO) adenocarcinoma. Risk stratification considering both GGO on CT and LVI may identify patients benefiting from increased surveillance.
The presence of ground-glass opacity portends different prognoses for lung adenocarcinoma. In stage I lung adenocarcinoma, lymphovascular invasion (LVI) was significantly more frequent in solid adenocarcinomas than in ground-glass opacity (GGO)-positive adenocarcinomas. LVI was not associated with overall survival in patients with either solid adenocarcinomas or GGO adenocarcinomas.
关于Ⅰ期肺腺癌中淋巴管侵犯（LVI）的预后意义仍存在争议。CT上的磨玻璃影（GGO）与腺癌中侵袭性较低或鳞屑样成分相关，这可能会影响预后因素的强度。本研究旨在探讨基于GGO存在情况的LVI在Ⅰ期肺腺癌中的预后价值。
回顾性分析2010年至2019年间接受肺叶切除术的Ⅰ期肺腺癌患者，根据CT将其分为GGO阳性或GGO阴性（实性腺癌）。对无病生存期（DFS）和总生存期（OS）进行多变量Cox回归分析，以评估基于GGO存在情况的病理LVI的预后意义。
纳入的924例患者（平均年龄62.5±9.2岁；505例女性）中，525例（56.8%）表现为GGO阳性腺癌，116例（12.6%）被诊断为LVI。实性腺癌中LVI的发生率显著高于GGO阳性腺癌（20.1%对6.9%，p<0.001）。多变量分析确定LVI和脏层胸膜侵犯（VPI）是实性腺癌患者DFS缩短的显著预后因素（LVI，风险比（HR）：1.89，p=0.004；VPI，HR：1.65，p=0.003），但在GGO阳性患者中并非如此（p=0.76和p=0.87）。相反，LVI在两组中均不是OS的显著预后因素（p>0.05）。
在Ⅰ期肺腺癌中，病理LVI仅与实性肺腺癌患者的DFS相关。
淋巴管侵犯（LVI）显著影响Ⅰ期实性肺腺癌患者的无病生存期，但不影响磨玻璃影（GGO）腺癌患者。同时考虑CT上的GGO和LVI进行风险分层可能会识别出受益于加强监测的患者。
磨玻璃影的存在预示着肺腺癌的不同预后。在Ⅰ期肺腺癌中，实性腺癌中淋巴管侵犯（LVI）的发生率显著高于磨玻璃影（GGO）阳性腺癌。LVI与实性腺癌或GGO腺癌患者的总生存期均无关。
