Proper clinical and pathologic T stage among diverse T descriptors in terms of recurrence after curative surgery for...

The clinical and pathologic T stage was revised for part-solid nodules in lung adenocarcinoma based on accumulating data. However, there are diverse clinical and pathologic T descriptors; therefore, this study aimed to investigate which T descriptors are the most appropriate for the clinical and pathologic T stage in terms of prognosis after curative surgery for stage I lung adenocarcinoma.

A total of 951 patients who underwent curative resection for pathologic stage I lung adenocarcinoma were reviewed. Two independent clinicians measured the total and solid sizes on lung and mediastinal window settings. The nonlepidic size was calculated from the pathologic report for invasive size. Univariate and multivariate analyses were conducted using each T descriptor for prognostic role identification.

The median age was 64 years (range, 25-86 years). Ground glass opacity (GGO) was present in 599 patients (63%). The median total tumor size and solid size in the lung window setting were 2 cm (range, 0.6-6.8 cm) and 1.3 cm (range, 0-5.5 cm), respectively. The median tumor size in the mediastinal window setting was 0.95 cm (range, 0-5.5 cm). Our multivariate analysis revealed that the solid size in the lung window setting (P=0.02) and the tumor size in the mediastinal window setting (P=0.02) were significantly associated with recurrence. The median total pathologic tumor size was 1.9 cm (range, 0.3-4 cm), the median nonlepidic tumor size 1 (NLTS1) was 1.12 cm (range, 0-4 cm), and the median nonlepidic size without fibrosis [nonlepidic tumor size 2 (NLTS2)] was 0.8 cm (range, 0-3.8 cm). NLTS1 (P=0.048) and NLTS2 (P=0.02) were significant predictors of recurrence in the multivariate analysis. However, 526 (55.3%) and 501 (52.8%) patients were stage 1A1 by the mediastinal window setting and NLTS2.

For stage I lung adenocarcinoma, in terms of the stage, the solid component on the lung window setting is a more suitable and reliable clinical T descriptor, and the nonlepidic size (NLTS1) is considered a more appropriate model for the pathologic T descriptor.