Prognostic Impact of Ground-Glass Opacity in Clinical Stage IA Non-Small Cell Lung Cancer With Interstitial Lung Abnormalities

TL;DR

In early-stage lung cancer with lung abnormalities, tumors with a ground-glass component have better cancer survival but similar overall survival due to higher non-cancer deaths.

Contribution

This study identifies the prognostic impact of ground-glass opacity in lung cancer patients with interstitial lung abnormalities.

Findings

Subsolid tumors with ground-glass opacity had significantly better recurrence-free and cancer-specific survival than pure solid tumors.

Higher non-cancer mortality after two years in subsolid tumors led to comparable overall survival between tumor types.

Comorbidity management may improve long-term outcomes in patients with interstitial lung abnormalities.

Abstract

Ground-glass opacity (GGO) component is a favourable prognostic factor in non-small cell lung cancer (NSCLC), whereas NSCLC with interstitial lung abnormalities (ILA) generally has poorer prognoses. We investigated the clinical significance of GGO in patients with NSCLC and ILA.

Among 1319 patients who underwent pulmonary resection for clinical stage IA NSCLC at 2 institutions between 2010 and 2020, we retrospectively assessed 216 patients with ILA based on preoperative CT. Patients were divided into 2 groups: pure solid tumours without GGO and subsolid tumours with GGO.

Among 216 patients with ILA, 146 (68%) had pure solid tumours and 70 (32%) had subsolid tumours. Subsolid tumours had significantly better prognoses than pure solid tumours (5-year overall survival, 69.7% vs 48.6%, P = .0008; 5-year recurrence-free survival, 69.7% vs 42.3%, P < .0001). Recurrence occurred in 4 patients (6%) with subsolid tumours and 41 (28%) with pure solid tumours. Although the 5-year cumulative incidence of lung cancer deaths was significantly lower in subsolid tumours than in those with pure solid tumours (2.6% vs 23.6%, P = .0011), an increase in other causes of mortality after 2 years post-surgery in subsolid tumours resulted in a comparable 5-year cumulative incidence of other causes of death (28.4% vs 36.1%, P = .260).

In clinical stage IA NSCLC with ILA, subsolid tumours have a lower lung cancer mortality than pure solid tumours; however, higher other-cause mortality after 2 years contributes to poorer overall survival. Optimizing comorbidity management may improve long-term prognosis.

Interstitial lung abnormalities (ILA), representing a wide range of pulmonary fibrotic disorders, are reported to be associated with an increased risk of lung cancer.

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