Predictors of Pathologic Tumor Invasion and Prognosis for Ground Glass Opacity Featured Lung Adenocarcinoma

Abstract

Background: We make surgical strategies for ground glass opacity (GGO) nodules currently based on thin-section (TS) computed tomography (CT) findings. Whether radiologic measurements could precisely predict tumor invasion and prognosis of GGO-featured lung adenocarcinoma is uncertain.

Methods: We retrospectively evaluated medical records of patients with radiologic GGO nodules undergoing a surgical procedure at Fudan University Shanghai Cancer Center. The study endpoints were the predictive value and prognostic significance of radiologic measurements (consolidation-to-tumor ratio value, consolidation size, and tumor size) for pathologic lung adenocarcinoma.

Results: In this study 736 patients and 841 GGO nodules were included. Five-year lung cancer-specific regression-free survival (LCS-RFS) rate was 95.76% (95% confidence interval [CI], 93.01% to 97.44%). The 5-year LCS overall survival (OS) rate was 98.99% (95% CI, 97.69% to 99.57%). Multivariable analysis showed that tumor invasion (invasive adenocarcinoma [IAD] vs adenocarcinoma in situ [AIS]/minimally invasive adenocarcinoma [MIA], p = 0.020) was the only independent predictor for 5-year LCS-RFS. IAD (hazard ratio, 15.98; 95% CI, 1.55 to 164.35) was correlated with a higher risk of recurrence. Kaplan-Meier analysis showed that only tumor invasion status (IAD vs AIS/MIA, p = 0.003) could predict 5-year lung cancer-specific overall survival (LCS-OS), and IAD had a worse LCS-OS than AIS and MIA. A part-solid component (odds ratio [OR], 9.09; 95% CI, 2.71 to 30.47; p = 0.000), large consolidation size (OR, 3.11; 95% CI, 1.03 to 9.40; p = 0.045), and large tumor size (OR, 5.48; 95% CI, 2.68 to 11.19; p = 0.000) were associated with pathologic IAD. For IAD ≤ 20 mm, segmentectomy and lobectomy had better 5-year LCS-RFS than wedge resection, although the difference was statistically insignificant (p = 0.367). The three types of surgeries provided the similar 5-year LCS-OS (p = 0.834).

Conclusions: Radiologic measurements could not precisely predict tumor invasion and prognosis. Making treatment strategies solely according to TS-CT findings for GGO tumor is inappropriate.