Prognosis of adenocarcinoma with innumerable pure ground-glass nodules and/or part-solid nodules

Abstract

Objectives: Although many studies have examined lung adenocarcinoma with multiple additional lesions with ground-glass opacity on high-resolution computed tomography including pure ground-glass nodules and part-solid nodules, no study has yet investigated patients who had resected adenocarcinoma with lesions of pure ground-glass nodule and/or part-solid nodule that were so numerous that it was impossible to resect all of them.

Methods: Among 5076 patients with resected adenocarcinoma, 877 (17.3%) had additional lesions of pure ground-glass nodule and/or part-solid nodule. Numerous lesions for which it is impossible to resect all of them (innumerable lesions) were defined as follows: 10 or more lesions are seen in 3 or more different lobes and at least 1 lesion is located in the inner two-thirds of each lobe. Of these, 73 patients with innumerable pure ground-glass nodules and/or part-solid nodules, and with clinical N0 were investigated in terms of clinicopathological features and oncological outcomes.

Results: For the main adenocarcinoma, 35 patients (47.9%) underwent sublobar resection. After the initial surgery, 23 patients (31.5%) showed the growth of residual lesions and this growth was often observed more than 2 years from the initial surgery. Surgery was selected for 19 (82.6%) of these 23 patients with lesions that had grown. The 5-year overall survival rate was 86.2%.

Conclusions: The prognosis of patients with resected adenocarcinoma with innumerable pure ground-glass nodules and/or part-solid nodules was favourable. Due to the possibility of the growth of residual lesions, sublobar resection should be considered for the main tumour at the initial surgery.

Keywords: Adenocarcinoma; GGN; GGO; Segmentectomy; Sublobar resection; Wedge resection.