OBJECTIVES
The aim of this study was to assess the clinical effects of a small ground-glass opacity (GGO) component of a radiologically nearly pure-solid tumour on tumour aggressiveness in patients with clinical stage IA non-small-cell lung cancer (NSCLC).
METHODS
Data of 988 patients with clinical stage IA NSCLC who had a consolidation-to-tumour ratio of ≥0.75 on high-resolution computed tomography were retrospectively analysed. The cumulative incidence of recurrence (CIR) was compared between patients with GGO (nearly pure-solid, n = 297) and those without GGO (pure-solid, n = 691).
RESULTS
In patients with clinical T1mi + T1a and T1b, the CIR was significantly higher in the pure-solid group than in the nearly pure-solid group (5-year CIR, 15.2% and 19.3% vs 0% and 6.4%; P < 0.001); however, this was not the case for patients with clinical T1c (5-year CIR, 23.1% vs 26.5%; P = 0.580). In the multivariable analysis, pure-solid tumours were independently associated with a higher CIR than nearly pure-solid tumours in patients with clinical T1mi + T1a + T1b (solid tumour size ≤2 cm; subdistribution hazard ratio, 3.25; 95% confidence interval, 1.59–6.63; P = 0.001) but not in those with clinical T1c tumours (2–3 cm; subdistribution hazard ratio, 0.67; 95% confidence interval, 0.39–1.13; P = 0.130).
CONCLUSIONS
Nearly pure-solid tumours with a small GGO component influence tumour aggressiveness based on solid tumour size, with a threshold of 2 cm in patients with clinical stage IA NSCLC. For tumours sized 2–3 cm, nearly pure-solid tumours had a similar tumour aggressiveness as pure-solid tumours.
Objectives
Pathological lymph node metastases are often observed in patients with clinical N0 lung cancer. Identifying preoperative predictors of occult hilar nodal metastasis is important in determining the surgical procedure in patients with clinical stage I non-small cell lung cancer. This study aimed to determine the frequency and predictors of occult hilar nodal metastasis by tumour location in these patients.
Methods
Between April 2007 and May 2019, data of patients who underwent lobectomy or segmentectomy for clinical stage I pure-solid non-small cell lung cancer were retrospectively reviewed. The ratio of the distance from the pulmonary hilum to the proximal side of the tumour to the distance from the pulmonary hilum to the visceral pleural surface through the centre of the tumour, named “distance ratio,” was calculated. The relationship of the distance ratio with clinicopathological findings and prognosis was discussed.
Results
A total of 357 patients were enrolled. Occult hilar nodal metastasis frequency was 14.6%. Patients were divided into two groups based on whether the distance ratio was ≤0.67 (central-type) or > 0.67 (peripheral-type). The frequency of occult hilar nodal metastasis was significantly higher in the distance ratio ≤0.67 group (21.5% vs 7.4%; P < 0.001). Multivariable analysis revealed that distance ratio was the only independent preoperative predictor of occult hilar nodal metastasis (odds ratio, 3.63; 95% confidence interval, 1.83–7.18; P < 0.001).
Conclusions
The frequency of occult hilar nodal metastasis was significantly higher in peripheral-type lung cancer; therefore, tumour location was the most important preoperative predictor of occult hilar nodal metastasis.
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