Prognostic effect of ground-glass opacity in subcentimeter invasive lung adenocarcinoma

Jinsong Bai; Fangqiu Fu; Wenrui Sun; Chaoqiang Deng; Zelin Ma; Shengping Wang; Lin Deng; Yang Zhang; Haiquan Chen

doi:10.21037/jtd-22-1260

Prognostic effect of ground-glass opacity in subcentimeter invasive lung adenocarcinoma

J Thorac Dis. 2023 Apr 28;15(4):1559-1571. doi: 10.21037/jtd-22-1260. Epub 2023 Mar 24.

Authors

Jinsong Bai^#^{1

2

3}, Fangqiu Fu^#^{1

2

3}, Wenrui Sun^#^{1

2

3}, Chaoqiang Deng^{1

2

3}, Zelin Ma^{1

2

3}, Shengping Wang^{2

3

4}, Lin Deng^{2

3

4}, Yang Zhang^#^{1

2

3}, Haiquan Chen^#^{1

2

3}

Affiliations

¹ Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
² Institute of Thoracic Oncology, Fudan University, Shanghai, China.
³ Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
⁴ Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.

^# Contributed equally.

Abstract

Background: Although subcentimeter nodules represent precursor or minimally invasive lung cancer in most cases, there are still a few that are subcentimeter invasive adenocarcinoma (IAC). The aim of this study was to investigate the prognostic effect of ground-glass opacity (GGO) and the optimal surgical procedure in this special group.

Methods: Patients with subcentimeter IAC were enrolled and were categorized into pure GGO, part-solid, and solid nodules based on the radiological appearance. Cox proportional hazards model and the Kaplan-Meier method were used for survival analyses.

Results: A total of 247 patients were enrolled. Among them, 66 (26.7%) were in the pure-GGO group, 107 (43.3%) were in the part-solid group, and 74 (30.0%) were in the solid group. Survival analysis demonstrated a significantly worse survival in the solid group. Cox multivariate analyses confirmed that the absence of GGO component was an independent risk factor for worse recurrence-free survival (RFS) and overall survival (OS). As for surgical procedures, lobectomy did not provide a significant better RFS or OS than sublobar resection in the whole cohort or in a subgroup of patients with solid nodules.

Conclusions: The radiological appearance stratified the prognosis of IAC with size of smaller than or equal to 1 cm. Sublobar resection may be feasible for subcentimeter IAC, even for those appearing as solid nodules; however, caution should be taken when applying wedge resection.

Keywords: Lung adenocarcinoma; ground-glass opacity (GGO); subcentimeter nodule.