Distinct clinicopathologic factors and prognosis based on the presence of ground-glass opacity components in patients with resected stage I non-small cell lung cancer

Background This study was to investigate the prognostic value of ground-glass opacity(GGO) components and to evaluate distinct the clinicopathological variables of survival outcomes for the pure-GGO, part-solid and solid groups of patients with resected stage I non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed the structured data for stage I NSCLC patients who had undergone the curative-intent surgical resection in the Lung Cancer Database of West China Hospital from 2009 to 2016. The eligible patients were divided into the pure-GGO, part-solid and solid groups according to the radiological manifestation. Univariate and multivariate Cox regression analyses were performed between the 3 groups. And we further evaluated the clinicopathological variables in each group separately. Results Among a total of 2,775 eligible patients enrolled into the cohort were 1,587 (57.19%) in the solid group, 508 (18.31%) in the part-solid group, and 680 (24.50%) in the pure-GGO group. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 98.8% and 98.0% in the pure-GGO group, 96.0% and 86.5% in the part-solid group, and 88.0% and 75.5% in the solid group, respectively (P<0.001). Presence of GGO components was a significantly favorable prognosticator (HR =0.415, 95% CI: 0.286-0.601). Different groups had distinct prognostic factors. LVI was the shared risk factor for groups with presence of GGO components in both part-solid and pure-GGO groups. Pathological stage (IA or IB) was influential exclusively for the pure-GGO group. In the solid group, females, younger patients, and patients without VPI had better survival. But such independent significance did not exist in the other two groups. Conclusions GGO component was a strong prognosticator of better prognosis in resected patients with stage I NSCLC. Prognostic factors and survival outcomes were disparate among the pure-GGO, part-solid, and solid group. Our results support the proposal that the next edition tumor-node-metastasis (TNM) classification should consider the importance of GGO components as a new T descriptor.