Prognostic impact of tumour spread through air space in radiological subsolid and pure solid lung adenocarcinoma

Yifan Zhong; Yong Xu; Jiajun Deng; Tingting Wang; Xiwen Sun; Donglai Chen; Chunyan Wu; Likun Hou; Huikang Xie; Yunlang She; Dong Xie; Chang Chen

doi:10.1093/ejcts/ezaa361

Prognostic impact of tumour spread through air space in radiological subsolid and pure solid lung adenocarcinoma

Eur J Cardiothorac Surg. 2021 Apr 13;59(3):624-632. doi: 10.1093/ejcts/ezaa361.

Authors

Yifan Zhong¹, Yong Xu¹, Jiajun Deng¹, Tingting Wang², Xiwen Sun², Donglai Chen¹, Chunyan Wu³, Likun Hou³, Huikang Xie³, Yunlang She¹, Dong Xie¹, Chang Chen¹

Affiliations

¹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
³ Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

PMID: 33188689
DOI: 10.1093/ejcts/ezaa361

Abstract

Objectives: The aim of the study was to investigate the relationship between ground-glass opacity (GGO) and tumour spread through air space (STAS), as well as their joint influence on the prognosis of stage I lung adenocarcinoma.

Methods: A total of 620 consecutive patients with surgically resected lung adenocarcinoma between January 2011 and December 2012 were reviewed retrospectively. The relevance of STAS and GGO was analysed by logistic regression, and their prognostic significance was investigated via the Kaplan-Meier method and Cox regression models. Furthermore, to determine the magnitude of the prognostic impact of GGO and STAS, we respectively performed survival analysis in subgroups according to the presence of STAS and GGO.

Results: Of all 620 cases, 26.7% were positive for STAS, and 32.9% had a GGO component. STAS was present in 10.8% of part-solid lesions and 34.9% of pure solid nodules (P < 0.001). Lepidic-predominant histologic subtype, GGO component and pathological T stage exhibited significant relevance to the presence of STAS. For the whole population, STAS and GGO component were each revealed as independent predictors for overall survival and recurrence-free survival (each with P < 0.001). Interestingly, in the GGO-present subgroup, STAS failed to significantly stratify prognosis. However, in the STAS-positive subgroup, the presence of a GGO component was independently associated with favourable oncological results.

Conclusions: STAS is associated with a GGO component, and each factor was a significant predictor for the prognosis of stage I lung adenocarcinoma. Moreover, the favourable prognostic impact of a GGO component was greater than the adverse prognostic influence of STAS, indicating that GGO is a more reliable prognostic predictor in stage I lung adenocarcinoma.

Keywords: Adenocarcinoma; Ground-glass opacity; Non-small-cell lung cancer; Prognosis; Recurrence; Tumour spread through air space.

MeSH terms

Adenocarcinoma of Lung* / diagnostic imaging
Adenocarcinoma of Lung* / pathology
Humans
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / pathology
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Retrospective Studies