수술로 절제된 비소세포성 폐암의 CT 및 병리 기반 하위 그룹의 특성: 재발 패턴과 예후

Abstract

Introduction: The purpose of this study was to investigate differences in recurrence patterns and prognosis in patients after surgical resection for non-small cell lung cancer (NSCLC) according to histologic subtype and the presence of ground-glass opacity (GGO). Methods: We included patients who underwent lobectomy or pneumonectomy for NSCLC between July 2010 and December 2017. Based on histologic subtype and the presence of a GGO component, patients were divided into three groups: GGO-adenocarcinoma (ADC), solid-ADC, and solid-non-ADC groups. Recurrence patterns on imaging examinations were compared among the three groups. Predictive factors for time to recurrence (TTR), postrecurrence survival (PRS), and overall survival (OS) were obtained using Cox proportional hazards model. Results: Out of 1478 patients, 522 were classified into the GGO-ADC group, 605 into the solid-ADC group, and 351 into the solid-non-ADC group. Recurrences occurred most frequently in the solid-ADC group (34.2% [207/605]), followed by the solid-non-ADC group (25.6% [90/351]), and the GGO-ADC group (16.9% [88/522]). Distant metastasis was the most common recurrence pattern in all groups and clinical stages. In the GGO-ADC group, all regional recurrences were ipsilateral lung metastasis (5.1% [21/412]) without regional lymph node metastasis in clinical stage I. Brain metastasis was most frequent in solid-ADC group (4.2% [16/377]) in clinical stage I. Subgroups were independent risk factors for TTR (hazard ratio [HR], 0.58 [p<.001] for GGO-ADC; HR, 0.70 [p=.005] for solid-ADC), PRS (HR, 0.46 [p=.001] for GGO-ADC; HR, 0.63 [p=.006] for solid-ADC), and OS (HR, 0.42 [p<.001] for GGO-ADC; HR, 0.67 [p=.02] for solid-ADC) with the solid- non-ADC group as the reference. Additionally, distant metastasis (HR, 1.98 [p<.001]) and particularly brain metastasis (HR, 3.56 [p<.001]), compared with locoregional recurrence, were independently associated with worse PRS. Conclusions: CT-pathology defined subgroups had different characteristics in recurrence patterns and prognosis in patients with resectable lung cancer.