Controversies on lung cancers manifesting as part-solid nodules

Area of Science:

• Pulmonary Medicine
• Oncology
• Radiology

Background:

• Part-solid nodules (PSNs) are a common presentation of early-stage lung cancer on CT scans.
• Understanding the prognostic implications of PSNs is vital for guiding treatment decisions.

Purpose of the Study:

• To summarize the survival outcomes of patients who underwent resection for lung cancers presenting as PSNs.
• To analyze survival based on the proportion of the solid component within PSNs.

Main Methods:

• A systematic literature search was conducted in PubMed/MEDLINE and EMBASE for studies on resected CT-detected lung cancers manifesting as PSNs.
• PSNs were categorized into two groups based on the percentage of the solid component: <80% and ≥80%.
• Lung cancer-specific survival (LCS), overall survival (OS), and disease-free survival (DFS) were the primary outcome measures.

Main Results:

• Studies reporting PSNs with <80% solid component showed high median DFS (100%) and OS (97.5%).
• Studies reporting PSNs with ≥80% solid component had lower median DFS (82.6%) and OS (85.5%).
• Both DFS and OS were consistently higher for PSNs with a smaller solid component (<80%).

Conclusions:

• Lung cancers presenting as PSNs generally have a slow growth pattern and favorable cure rates.
• A precise definition of the solid component's upper limit in PSNs is essential to prevent misclassification and ensure accurate prognostication.
• Management strategies for PSNs should consider the size of the solid component, as it correlates with different cell types and patient outcomes.