Gil Bo Mi, Jeon Hyun Woo, Kim Young-Du
Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2025 Aug 31;17(8):5960-5971. doi: 10.21037/jtd-2025-806. Epub 2025 Aug 28.
The clinical and pathologic T stage was revised for part-solid nodules in lung adenocarcinoma based on accumulating data. However, there are diverse clinical and pathologic T descriptors; therefore, this study aimed to investigate which T descriptors are the most appropriate for the clinical and pathologic T stage in terms of prognosis after curative surgery for stage I lung adenocarcinoma.
A total of 951 patients who underwent curative resection for pathologic stage I lung adenocarcinoma were reviewed. Two independent clinicians measured the total and solid sizes on lung and mediastinal window settings. The nonlepidic size was calculated from the pathologic report for invasive size. Univariate and multivariate analyses were conducted using each T descriptor for prognostic role identification.
The median age was 64 years (range, 25-86 years). Ground glass opacity (GGO) was present in 599 patients (63%). The median total tumor size and solid size in the lung window setting were 2 cm (range, 0.6-6.8 cm) and 1.3 cm (range, 0-5.5 cm), respectively. The median tumor size in the mediastinal window setting was 0.95 cm (range, 0-5.5 cm). Our multivariate analysis revealed that the solid size in the lung window setting (P=0.02) and the tumor size in the mediastinal window setting (P=0.02) were significantly associated with recurrence. The median total pathologic tumor size was 1.9 cm (range, 0.3-4 cm), the median nonlepidic tumor size 1 (NLTS1) was 1.12 cm (range, 0-4 cm), and the median nonlepidic size without fibrosis [nonlepidic tumor size 2 (NLTS2)] was 0.8 cm (range, 0-3.8 cm). NLTS1 (P=0.048) and NLTS2 (P=0.02) were significant predictors of recurrence in the multivariate analysis. However, 526 (55.3%) and 501 (52.8%) patients were stage 1A1 by the mediastinal window setting and NLTS2.
For stage I lung adenocarcinoma, in terms of the stage, the solid component on the lung window setting is a more suitable and reliable clinical T descriptor, and the nonlepidic size (NLTS1) is considered a more appropriate model for the pathologic T descriptor.
基于不断积累的数据，对肺腺癌部分实性结节的临床和病理T分期进行了修订。然而，临床和病理T描述符存在差异；因此，本研究旨在探讨在I期肺腺癌根治性手术后的预后方面，哪些T描述符最适合临床和病理T分期。
回顾了951例行I期肺腺癌根治性切除术的患者。两名独立的临床医生在肺窗和纵隔窗设置下测量肿瘤的总体积和实性部分体积。根据病理报告计算浸润性部分的非鳞屑状体积。使用每个T描述符进行单因素和多因素分析，以确定其预后作用。
中位年龄为64岁（范围25 - 86岁）。599例患者（63%）存在磨玻璃影（GGO）。肺窗设置下肿瘤的中位总体积和实性部分体积分别为2 cm（范围0.6 - 6.8 cm）和1.3 cm（范围0 - 5.5 cm）。纵隔窗设置下肿瘤的中位大小为0.95 cm（范围0 - 5.5 cm）。我们的多因素分析显示，肺窗设置下的实性部分体积（P = 0.02）和纵隔窗设置下的肿瘤大小（P = 0.02）与复发显著相关。病理肿瘤的中位总体积为1.9 cm（范围0.3 - 4 cm），中位非鳞屑状肿瘤大小1（NLTS1）为1.12 cm（范围0 - 4 cm），无纤维化的中位非鳞屑状体积[非鳞屑状肿瘤大小2（NLTS2）]为0.8 cm（范围0 - 3.8 cm）。多因素分析中，NLTS1（P = 0.048）和NLTS2（P = 0.02）是复发的显著预测因素。然而，根据纵隔窗设置和NLTS2，分别有526例（55.3%）和501例（52.8%）患者为1A1期。
对于I期肺腺癌，就分期而言，肺窗设置下的实性成分是更合适、更可靠的临床T描述符，非鳞屑状体积（NLTS1）被认为是病理T描述符的更合适模型。
