JTO Clinical and Research Reports (May 2022)

Presence of a Ground-Glass Opacity Component Is the True Prognostic Determinant in Clinical Stage I NSCLC

  • Akira Hamada, MD,
  • Kenichi Suda, MD, PhD,
  • Toshio Fujino, MD, PhD,
  • Masaya Nishino, MD, PhD,
  • Shuta Ohara, MD, PhD,
  • Takamasa Koga, MD, PhD,
  • Takanobu Kabasawa, MD, PhD,
  • Masato Chiba, MD, PhD,
  • Masaki Shimoji, MD, PhD,
  • Makoto Endoh, MD, PhD,
  • Toshiki Takemoto, MD, PhD,
  • Junichi Soh, MD, PhD,
  • Naoki Yanagawa, MD, PhD,
  • Satoshi Shiono, MD, PhD,
  • Tetsuya Mitsudomi, MD, PhD

Journal volume & issue
Vol. 3, no. 5
p. 100321

Abstract

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Introduction: Recent studies have suggested that including presence or absence of ground-glass opacity (GGO) may improve the tumor descriptor (T descriptor) classification in clinical stage I NSCLC. In this study, we analyzed prognostic implications of presence or absence of GGO, size of the solid component, and predominant histology to identify the true prognostic determinant for early-stage NSCLC. Methods: We retrospectively examined 384 patients with clinical stage I NSCLC (solid: 242, part solid: 142) who underwent complete resection between 2009 and 2013. Results: Survival curves of the whole cohort revealed good separation using the current TNM classification. Nevertheless, the part-solid group had a favorable prognosis irrespective of solid component size. Conversely, patients in the solid tumor group with tumors between 3 and 4 cm had a worse prognosis than patients whose tumors were less than or equal to 3 cm. Thus, we propose the following novel T descriptor classification: IA, part-solid tumors; IB, solid tumors less than or equal to 3 cm; and IC, solid tumors between 3 and 4 cm. This novel classification system stratified patient prognosis better than the current classification. On pathologic evaluation, the part-solid group always had better prognoses than the solid group in each subgroup divided by pathologic grade. Conclusions: These results suggest that presence of GGO is the true prognostic determinant of stage I NSCLC, irrespective of the size of the solid component. Our novel T descriptor classification system could more accurately predict prognoses of clinical stage I NSCLC cases.

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