Introduction: We evaluated differences in the clinicopathologic characteristics and prognosis based on the presence of ground glass opacity (GGO) components in small-sized lung adenocarcinoma. Methods:We retrospectively investigated 634 lung adenocarcinomas classed as c-stage IA in the eighth edition TNM classification. Staging was defined according to the solid component size measured by thin-section computed tomography. All tumors were grouped into either a GGO or solid group, based on the presence of a GGO component.Results: Of the cases, 215 (34%) were classed as c-stage IA1 (T1mi: 88, T1a-GGO: 102, T1a-solid: 25), 255 (40%) as c-stage IA2 (T1b-GGO: 122, T1b-solid: 133), and 164 (26%) as c-stage IA3 (T1c-GGO: 44, T1c-solid: 120). Among the 546 c-stage IA cases excluding the T1mi lesions, Cox regression analysis revealed that presence of GGO was an independently significant prognosticator (p ¼ 0.024). The result was validated in 494 c-stage IA lung adenocarcinomas with a nonpredominant GGO component, showing the presence of GGO as a significant prognosticator (p ¼ 0.048). When we evaluated the prognostic impact of GGO presence in each clinical stage, the 5-year overall survival (OS) was significantly different between the GGO and solid groups (IA1: 97.8% versus 86.6%, p ¼ 0.026; IA2: 89.3% versus 75.2%, p ¼ 0.007; IA3: 88.5% versus 62.3%, p ¼ 0.003). Furthermore, the 5-year overall survival b was distinct in parallel similar pathologic findings when comparing a lepidic versus an invasive component (IA1: 97.9% versus 85.6%, p ¼ 0.031; IA2: 86.1% versus 69.4%, p ¼ 0.007; IA3: 77.5% versus 55.8%, p < 0.001).Conclusions: Clinicopathologic and oncologic outcomes were disparate based on the presence of a GGO component in the eighth edition TNM classification of c-stage IA lung adenocarcinoma.

Recently, an association between tumor infiltrating Forkhead box P3 regulatory T cells (T reg ) and an unfavorable prognosis has been clinically shown in some cancers, but the mechanism of T reg induction in the tumor microenvironment remains uncertain. The aims of the present study were to examine the relationship between T reg and patient outcome and to investigate whether T reg induction is influenced by the characteristics of cancer-associated fibroblasts (CAF) in lung adenocarcinoma. The numbers of T reg in both the tumor stroma and the tumor nest were counted in 200 consecutive pathological stage I lung invasive adenocarcinoma specimens. To examine whether the characteristics of CAF influence T reg induction, we selected and cultured CAF from low T reg and high T reg adenocarcinoma. The number of T reg was much higher in the stroma than in the nest (P < 0.01). Patients with high T reg had a significantly poorer prognosis than those with low T reg (overall survival: P = 0.03; recurrence-free survival: P = 0.02; 5-year overall survival: 85.4% vs 93.0%). Compared with the CAF from low T reg adenocarcinoma, culture supernatant of the CAF from high T reg adenocarcinoma induced more T reg (P = 0.01). Also, CAF from high T reg adenocarcinoma expressed significantly higher mRNA levels of transforming growth factor-b (P = 0.01) and vascular endothelial growth factor (P = 0.01), both of which are involved in T reg induction. Our studies suggest the possibility that CAF expressing immunoregulatory cytokines may induce T reg in the stroma, creating a tumor-promoting microenvironment in lung adenocarcinoma that leads to a poor outcome. (Cancer Sci 2013; 104: 409-415)

CD204 (+) TAMs were an independent prognostic factor in lung squamous cell carcinoma. CD204 (+) TAMs, along with other tumor-promoting stromal cells such as regulatory T cells and endothelial cells, may create tumor-promoting microenvironments.

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Digital monitoring of peak air leakage and patterns of air leakage were useful for predicting prolonged air leak after pulmonary resection. Information on the disappearance of air leak could be derived from the change in the rate of air leakage and from the increase in fluctuation of pleural pressure.

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Our combined exercise plus diet program may contribute to improvement in cardiorespiratory fitness and body weight compared with control group.