Chen Chao, Xu Shao-Jun, Du Xiao-Qiang, Tu Jia-Hua, Yan Ren-He, Chen Hui, Divisi Duilio, Um Sang-Won, Luo Yun-Fan, Zhang Zhi-Fan, You Cheng-Xiong, Yu Shao-Bin, Chen Shu-Chen
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
Transl Lung Cancer Res. 2024 Dec 31;13(12):3629-3641. doi: 10.21037/tlcr-24-923. Epub 2024 Dec 19.
Ground-glass opacity (GGO) on computed tomography (CT) has been suggested as a potential prognostic factor in lung adenocarcinoma (LUAD), but its significance in patients with pathological stage IA3 LUAD, particularly in relation to micropapillary (MIP) status, remains unclear. This study addresses the clinical need to stratify patients based on GGO and MIP status to optimize prognosis prediction and follow-up strategies.
A multicenter retrospective study was conducted on 411 patients with pathological stage IA3 LUAD, enrolled between July 2012 and July 2020. Patients were divided into two groups based on the presence of GGO. The association of GGO with recurrence-free survival (RFS) and cancer-specific survival (CSS) of patients with different MIP status was assessed, stratified by MIP status (MIP ≥5% was classified as positive, and MIP <5% as negative). A life-table analysis was used to calculate dynamic recurrence curves of subgroups formed by GGO and MIP and to establish a personalized follow-up strategy.
The analysis indicated that GGO was associated with prolonged RFS (P<0.001) and CSS (P=0.006) in MIP-negative patients but not for MIP-positive patients. Time-dependent Cox multivariate analysis further showed that GGO was a favorable prognostic factor for RFS (P=0.03) and CSS (P=0.04) even at 2 years postoperatively. Based on GGO components and MIP status, patients were categorized into the four following subgroups: MIP(+)-GGO(+), MIP(+)-GGO(-), MIP(-)-GGO(+), and MIP(-)-GGO(-); the recommended number of follow-up visits for these four subgroups within 5 years were 3, 9, 3, and 11, respectively.
The GGO component demonstrated a beneficial prognostic effect primarily in MIP-negative patients with pathological stage IA3 LUAD, sustained for up to 2 years. The variation in recurrence risk across subgroups underscores the importance of personalized follow-up strategies based on GGO and MIP status to optimize patient monitoring and care.
计算机断层扫描（CT）上的磨玻璃影（GGO）被认为是肺腺癌（LUAD）的一个潜在预后因素，但其在病理分期为IA3期的LUAD患者中的意义，尤其是与微乳头（MIP）状态的关系仍不清楚。本研究旨在满足基于GGO和MIP状态对患者进行分层的临床需求，以优化预后预测和随访策略。
对2012年7月至2020年7月期间登记的411例病理分期为IA3期的LUAD患者进行了一项多中心回顾性研究。根据是否存在GGO将患者分为两组。评估不同MIP状态患者的GGO与无复发生存期（RFS）和癌症特异性生存期（CSS）的相关性，并按MIP状态分层（MIP≥5%分类为阳性，MIP<5%分类为阴性）。采用寿命表分析计算由GGO和MIP组成的亚组的动态复发曲线，并建立个性化的随访策略。
分析表明，GGO与MIP阴性患者的RFS延长（P<0.001）和CSS延长（P=0.006）相关，但与MIP阳性患者无关。时间依赖性Cox多变量分析进一步表明，即使在术后2年，GGO仍是RFS（P=0.03）和CSS（P=0.04）的有利预后因素。根据GGO成分和MIP状态，患者被分为以下四个亚组：MIP(+)-GGO(+)、MIP(+)-GGO(-)、MIP(-)-GGO(+)和MIP(-)-GGO(-)；这四个亚组在5年内建议的随访次数分别为3次、9次、3次和11次。
GGO成分主要在病理分期为IA3期的MIP阴性LUAD患者中显示出有益的预后作用，可持续长达2年。各亚组复发风险的差异强调了基于GGO和MIP状态的个性化随访策略对于优化患者监测和护理的重要性。
