Validation of the Eighth Edition Clinical T Categorization System for Clinical Stage IA, Resected Lung Adenocarcinomas: Prognostic Implications of the Ground-Glass Opacity Component

Abstract

Introduction: There is controversy regarding the clinical T (cT) category of lung adenocarcinomas that manifest as part-solid nodules (PSNs). We aimed to validate the cT category and to evaluate the independent prognostic role of the nodule type (i.e., part-solid versus solid). Methods: We retrospectively evaluated the prognostic value of clinico-radiologic factors regarding the overall survival of patients with clinical stage IA lung adenocarcinomas that were resected between 2008 and 2014. cT Category, nodule type, and their interaction term were included in the multivariable Cox regression analysis with other variables. In addition, a mixture cure model analysis was performed to investigate the association between the covariates and long-term survival. Results: A total of 744 patients (420 women; 362 PSNs; median age, 63 y) were included. The multivariableadjusted hazard ratio (HR) of the nodule type was not significant (1.30, 95% confidence interval [CI]: 0.80-2.10, p ¼ 0.291). However, the cT categories were significantly associated with overall survival (HR of cT1b, 2.33 [95% CI: 1.07-5.06, p ¼ 0.033]; HR of cT1c, 5.74 [95% CI: 2.51-13.12, p < 0.001]). There were no interactions between the nodule type and the cT categories (all p > 0.05). The multivariable mixture cure model revealed that solid nodules were associated with a decreased probability of long-term survival (OR ¼ 0.40, 95% CI: 0.18-0.92, p ¼ 0.030). In addition, cT1c was a negative predictor of long-term survival (OR ¼ 0.26, 95% CI: 0.07-0.94, p ¼ 0.040). Conclusions: The cT categorization system is valid for PSNs and solid nodules. Nevertheless, PSNs are a prognostic factor associated with long-term survival.

Lung cancer screening strategy for non-high-risk individuals: a narrative review

“…For instance, although smoking is considered to be a main risk factor of lung cancer, the majority of smokers will not develop lung cancer in their lifetime (37) and some never-smokers might also develop lung cancer. Moreover, the percentage of never smokers in lung cancer patients is about 10% to 20% in western countries (38), but it is as high as 50% to 63% in east-Asian population (39)(40)(41). Mechanically, gene nutation might be a significant factor and some genetic variations might contribute to the carcinogenesis of non-small cell lung cancer regardless of smoking history.…”

A Few Clouds Over the Eighth Edition T Categorization System

“…It most often affects the skin, but there are also reports of other organs and systems, such as the lung, gastrointestinal tract, muscle, and central nervous system being affected. 1 It is reported that several chemotherapy and target therapy drugs can cause RRR. With the emergence and frequent use of immune checkpoint inhibitors (ICIs), reports of immunotherapy-induced RRR began to appear in the literature.…”

“…The incidence of RRR triggered by chemotherapeutic drugs is 8.8%. 1 The incidence of RRP caused by targeted therapy is 4.4%. 3 The incidence of RRR induced by ICI is unknown owing to the rarity of the disease.…”

“…We read carefully with interest the article by Kim et al 1 In this study, they further validated the clinical T category and evaluated the independent prognostic role of the nodule type. Interestingly, the nodule type was not an independent prognostic factor, whereas cT1c and solid portion size were independent prognostic factors in the part-solid nodule subgroup.…”

Single-cell characterization of subsolid and solid lesions in the lung adenocarcinoma spectrum

“…Subsolid nodules often represent premalignancy or early spectrum lung adenocarcinoma, including premalignant lesions of atypical adenomatous hyperplasia and adenocarcinoma in situ, minimally invasive adenocarcinoma, or lepidic predominant invasive adenocarcinoma (Travis et al, 2016). Studies suggest that subsolid nodules that are predominantly ground glass portend a significantly better prognosis compared to lung adenocarcinomas (ADC) that present as part-solid or solid lesions (Aokage et al, 2018;Berry et al, 2018;Hattori et al, 2017;Kim et al, 2020). Some subsolid nodules remain stable for many years while others may progress to invasive disease.…”