Prognostic Impact of Ground-Glass Opacity in Clinical Stage IA Non-Small Cell Lung Cancer With Interstitial Lung Abnormalities.

OBJECTIVES

Ground-glass opacity (GGO) component is a favourable prognostic factor in non-small cell lung cancer (NSCLC), whereas NSCLC with interstitial lung abnormalities (ILA) generally has poorer prognoses. We investigated the clinical significance of GGO in patients with NSCLC and ILA.

METHODS

Among 1319 patients who underwent pulmonary resection for clinical stage IA NSCLC at 2 institutions between 2010 and 2020, we retrospectively assessed 216 patients with ILA based on preoperative CT. Patients were divided into 2 groups: pure solid tumours without GGO and subsolid tumours with GGO.

RESULTS

Among 216 patients with ILA, 146 (68%) had pure solid tumours and 70 (32%) had subsolid tumours. Subsolid tumours had significantly better prognoses than pure solid tumours (5-year overall survival, 69.7% vs 48.6%, P = .0008; 5-year recurrence-free survival, 69.7% vs 42.3%, P < .0001). Recurrence occurred in 4 patients (6%) with subsolid tumours and 41 (28%) with pure solid tumours. Although the 5-year cumulative incidence of lung cancer deaths was significantly lower in subsolid tumours than in those with pure solid tumours (2.6% vs 23.6%, P = .0011), an increase in other causes of mortality after 2 years post-surgery in subsolid tumours resulted in a comparable 5-year cumulative incidence of other causes of death (28.4% vs 36.1%, P = .260).

CONCLUSIONS

In clinical stage IA NSCLC with ILA, subsolid tumours have a lower lung cancer mortality than pure solid tumours; however, higher other-cause mortality after 2 years contributes to poorer overall survival. Optimizing comorbidity management may improve long-term prognosis.