Huang James, Tan Kay See, Altorki Nasser, Antonoff Mara, Blackmon Shanda, Bueno Raphael, Burt Bryan, Demmy Todd, Evans Nathaniel, Donahoe Laura, Harpole David, Jarrar Doraid, Kozower Benjamin, Lanuti Michael, Liberman Moishe, Lin Jules, Liou Douglas, Liptay Michael, Luketich James, Pennathur Arjun, Petersen Gerard, Ripley Robert, Rochefort Matthew, Seder Christopher W, Shrager Joseph, Su Stacey, Tong Betty, Shargall Yaron, Vaporciyan Ara, Waddell Thomas, Weksler Benny, Wigle Dennis, Yendamuri Sai, Jones David R
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2025 Apr;169(4):1100-1107. doi: 10.1016/j.jtcvs.2024.09.054. Epub 2024 Oct 10.
Presentation with multiple ground-glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs.
Patients with ≥2 GGOs (ground-glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit.
Target accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). One half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size.
Active surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety end points and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.
表现为多发磨玻璃影（GGOs）的情况越来越常见，而这些病灶的最佳处理方法尚不清楚。主动监测已越来越多地被用作其他低级别恶性肿瘤的一种管理策略。我们假设主动监测对于多发GGOs患者可能是一种可行且安全的选择。
纳入有≥2个GGOs（以磨玻璃影为主，实性成分<50%，≤3 cm）的患者进入一个多机构登记系统，并每6至12个月通过计算机断层扫描对其进行主动监测的前瞻性随访。每次随访时对每个GGO进行单独编目和测量。
达到了目标入组人数，有来自23个机构的337例患者。平均年龄为70岁（四分位间距，65 - 77岁），74%为女性。大多数为既往吸烟者（70%）或当前吸烟者（9%），平均吸烟量为30包年（四分位间距[IQR]，15 - 44包年）。一半的患者（51%）曾患肺癌，并且大多数（86%）在研究入组时已在接受监测。每位患者GGOs的中位数为3个（IQR，2 - 5），共有1467个GGOs处于监测中。GGOs的中位数大小为0.9 cm（IQR，0.7 - 1.3 cm）。大多数GGOs大小为0.5至1 cm。
主动监测而非立即干预对患者来说是一个可接受的选择，并且该登记试验的入组是可行的。将根据方案在计划的5年随访中评估安全性终点和长期结局。
