Subsolid Lesions Exceeding 3 Centimeters: The Ground-Glass Opacity Component Still Matters.

Area of Science:

• Pulmonology
• Oncology
• Thoracic Surgery

Background:

• Previous studies on ground-glass opacities (GGO) and lung adenocarcinoma prognosis were limited to small tumors (≤3 cm).
• The prognostic value of GGO in larger subsolid lesions (>3 cm) compared to solid nodules remains under investigation.

Purpose of the Study:

• To determine if the GGO component in subsolid lung adenocarcinoma lesions exceeding 3 cm predicts a better prognosis than solid nodules within the same clinical T category.
• To evaluate the prognostic significance of GGO in large lung adenocarcinoma.

Main Methods:

• A cohort of 1010 patients with completely resected clinical N0 lung adenocarcinoma (2010-2015) was analyzed, including 860 solid and 150 subsolid lesions >3 cm.
• Propensity score matching, adjusting for solid component size, was employed to compare prognostic outcomes between GGO and solid lesion groups.
• 144 matched pairs of patients were analyzed.

Main Results:

• The GGO group demonstrated significantly better overall survival (P=.011) and recurrence-free survival (P=.003) compared to the solid group after propensity score matching.
• These survival benefits were consistent in patients with solid-predominant lesions and across different clinical T categories.
• No significant difference in the size of the solid component was observed between the GGO and solid groups (mean 23.7 mm vs 24.4 mm, P=.450).

Conclusions:

• Lung adenocarcinoma with a GGO component exceeding 3 cm offers a better prognosis than solid nodules of similar size within the same clinical T category.
• Incorporating the GGO component into the clinical T classification system may enhance prognostic accuracy for lung cancers larger than 3 cm.