Prognostic Classification of Multiple Primary Lung Cancers Based on a Ground-Glass Opacity Component

Area of Science:

• Pulmonology
• Oncology
• Radiology

Background:

• Assessing prognostic factors for multiple primary lung cancers is crucial for accurate clinical T classification.
• Thin-section computed tomography (CT) is a key imaging modality for lung cancer evaluation.
• The prognostic impact of ground-glass opacity (GGO) components in CT findings for multiple lung cancers requires further elucidation.

Purpose of the Study:

• To evaluate the prognostic significance of GGO components on CT for refining the clinical T classification of multiple primary lung cancers.
• To determine if the presence and pattern of GGOs influence survival outcomes in patients with multiple lung cancers.

Main Methods:

• A retrospective review of 272 surgically resected, clinically node-negative multiple lung cancers.
• Classification of dominant tumors into GGO tumors (consolidation tumor ratio [CTR] 0 to <1.0) or pure-solid (PS) tumors (CTR = 1.0).
• Definition of multifocal GGOs (MFGGOs) as lesions with GGO components in all tumors; prognosis evaluated using Cox proportional hazard models.

Main Results:

• Multifocal GGOs (MFGGOs) showed significantly better 5-year overall survival (97.2%) compared to non-MFGGOs (68.5%).
• MFGGO and absence of nodal involvement were independent predictors of better survival.
• In non-MFGGO groups, PS + PS pattern and nodal involvement were independent predictors of poorer survival, with 5-year survival rates of 97.2% for MFGGO, 82.1% for PS + additional GGO, and 41.3% for PS + PS.

Conclusions:

• The presence of a GGO component is a significant prognostic indicator for survival in multiple lung cancers.
• Findings suggest that GGO presence can help distinguish survival outcomes, potentially aiding in refined T classification.
• Further multicenter trials are warranted to validate these findings and revise T-stage criteria for multiple lung cancers based on GGO components.