Clinicopathological Features and Prognosis of Lung Adenocarcinoma Presenting as Ground-Glass Opacity: A Single-Center Experience.

Objectives

Adenocarcinoma presenting as ground-glass opacities (GGOs) often corresponds to lepidic growth tumor and is associated with less invasive behavior and a good prognosis. The aim of this study is to investigate the correlation between radiological and pathological findings of GGO and their relationship with lung cancer-specific survival (LCSS) and incidence of relapses to better define their surgical management.

Methods

One hundred seventy-two patients underwent lung resection for adenocarcinoma presenting as pure GGO or partial solid GGO at CT scan. Based on consolidation-to-tumor ratio (CTR) at CT scan, patients were categorized into two groups: pure GGO (CTR 0) and partial solid GGO (CTR ≤ 0.5, 0.5 < CTR ≤ 0.75, and 0.75 < CTR ≤ 1.0). Histological analysis confirmed diagnosis, invasiveness, and grading.

Results

Comparing the group with pure GGO (n = 90; 52.3%) and the groups with partial solid GGO (n = 82; 47.7%), invasive adenocarcinoma was significantly more frequent in the last one (p = 0.0006). In the partial solid GGO group, the majority of tumors were G2, and the percentage of G3 tumors increased with the CTR increasing (p < 0.0001). Twenty-one (12.2%) patients experienced disease recurrence: 16 (9.3%) were invasive adenocarcinoma (IA), and 5 (2.9%) were minimally invasive adenocarcinomas (MIA); radiologically, 13 (7.5%) were pure GGO, and 8 (4.6%) had a solid component. At multivariate analysis, relapse was associated with age > 60 (p = 0.037), clinical stage ≥ cIB (p = 0.002), and sublobar resection (p = 0.005).

Conclusions

Pure GGO was associated with minor invasiveness, with prognosis dependent on age, clinical stage, and type of surgery (sublobar vs. lobar resection). Sublobar resections had a higher recurrence risk.