Clinicopathological and Prognostic Disparities in Part-Solid Versus Pure Solid Pulmonary Nodules as Early-Stage Lung...

The optimal surgical strategy for early-stage lung adenocarcinoma appearing as part-solid nodules (PSN) versus pure solid nodules (SPN) remains debated. This study directly compares their clinicopathological features, surgical outcomes, and recurrence patterns to inform personalized management based on CT characteristics.

This retrospective study analyzed 710 surgical patients with clinical stage IA lung adenocarcinoma. Nodules were categorized as PSN or SPN by the presence of a GGO component on preoperative CT. Interaction-effect analysis assessed CT-attenuation dynamics in solid components. Propensity-score matching balanced intergroup confounders, and Cox regression identified recurrence risk factors for each type.

Mean CT-solid value (-13.2 Hu vs. 22.2 Hu, p < 0.001) and the trend of change in CT-solid value during follow-up (Interaction effect Index: -0.011078, p < 0.001) were significantly different between PSN and SPN. Upon histological examination, PSN had significantly lower incidences of visceral pleural invasion (11.7% vs. 30.4%, p < 0.001) and lymph node metastasis (11.2% vs. 20.6%, p = 0.008) than SPN. After propensity-score matching, patients with PSN had significantly better recurrence-free survival (86.8% vs. 70.7%, p < 0.001) than those with SPN. In Cox regression analysis, sublobar resection and lymph node sampling-only were associated with increased risk of loco-regional recurrence in SPN, but not in PSN.

PSN and SPN show distinct clinicopathological features and prognostic profiles, suggesting potentially different biological behaviors. CT features need to be incorporated with clinical tumor stage in deciding surgical strategies on resection extent and lymph node examination for early-stage lung adenocarcinoma.