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评估在周围型IA期肺癌中采用薄层CT非侵袭性标准预测病理非浸润性的可行性。
2002年开启了前瞻性、多中心、观察性的JCOG0201研究，目的是研究肺腺癌的放射学非侵袭性标准预测病理非浸润性的可行性。研究者最终将肿瘤长径≤2 cm、实性/肿瘤比率（consolidation/tumor ration, CTR）≤0.25确定为非浸润性肺癌的放射学标准，术前以此来判断病理无淋巴结转移、无脉管浸润的特异度可以达98.7%。
在探索性分析中，对于≤2 cm且CTR≤0.25的肿瘤，诊断非侵袭性腺癌特异性的点估计为98.7%。
545例。 入组条件：周围型GGO，≤3cm 结果： 周围型GGO，＜2cm，C/T值＜25%为非侵袭性（未侵犯淋巴结/血管/淋巴管） JCOG 0201 非侵袭性周围型GGO肺叶切除术，5年RFS为 97.1%。 评论：JCOG 0201肺叶切除术5年RFS与JCOG 0804 （5年RFS为99.7%）结果相似。 提出结论：对于AIS，MIA楔形已足够。 CT表现以纯GGO为主，实性成分 ＜5mm
C/T比（C/T ratio） C，consolidation T，Maximal tumor diameter 影像学非侵袭性肺癌（Radiological noninvasive lung cancer）的定义：C/T ratio≤0.25
JCOG0201研究中临床IA期非小细胞肺癌GGO成分的预后评价
Objective: We performed a validation study to confirm the prognostic importance of the presence of a ground-glass opacity component based on data of the Japan Clinical Oncology Group study, JCOG0201, which was a prospective observational study to predict the pathological noninvasiveness of clinical stage IA lung cancer in Japan.
Methods: Among the 811 patients registered in JCOG0201, 671 were confirmed eligible by study monitoring and a central review of computed tomography. Registered c-stage IA lung cancer was less than 30 mm in maximum tumor size, which was classified into a with ground-glass opacity group (pure ground-glass opacity and part-solid tumor) or solid group based on the status of a ground-glass opacity component. T staging was reassigned in accordance with the 8th edition of the TNM staging system. To validate the prognostic impact, overall survival was estimated.
Results: Of the cases, 432 (64%) were in the with ground-glass opacity group and 239 (36%) were in the solid group with a median follow-up time of 10.1 years. The 5-year overall survival was significantly different between the with ground-glass opacity group and solid group (95.1% vs 81.1%). The 5-year overall survival was excellent regardless of the solid component size in the with ground-glass opacity group (c-T1a or less: 97.2%, c-T1b: 93.4%, c-T1c: 91.7%). In contrast, prognostic impact of the tumor size was definitive in the solid group (c-T1a: 87.5%, c-T1b: 85.9%, c-T1c: 73.7%).
Conclusions: Favorable prognostic impact of the presence of a ground-glass opacity component was demonstrated in JCOG0201. The presence or absence of a ground-glass opacity should be considered as an important parameter in the next clinical T classification.
PERSPECTIVE
The results of a significant center validation in Japan demonstrated that the favorable prognostic impact of the presence of a GGO component was confirmed in the prospective JCOG0201 dataset.
The presence or absence of a GGO should be strongly considered as a novel important parameter in the next clinical T classification.
Aritoshi Hattori1, *Kenji Suzuki1, Kazuya Takamochi1, Teruaki Koike2, Masashi Wakabayashi3, Keiju Aokage4, Hisashi Saji5, Hiroshige Yoshioka6, Yoshitaka Zenke7, Yasuhiro Tsutani8, Hiroyuki Ito9, Tadashi Aoki2, Kazuo Nakagawa10, Jiro Okami11, *Morihito Okada8, Yuya Sato3, Tomonori Mizutani3, Shun-ichi Watanabe10
1Juntendo University, Tokyo, Japan;2Niigata Cancer Center Hospital, Niigata, Japan; 3JCOG Data Center, National Cancer Center Hospital, Tokyo, Japan;4National Cancer Center Hospital East, Chiba, Japan; 5St. Marianna University, Kanagawa, Japan; 6Kansai Medical University Hospital, Osaka, Japan;7Tokyo Metropolitan Cancer and Infectious Disease Center, Tokyo, Japan;8Hiroshima University, Hiroshima, Japan;9Kanagawa Cancer Center, Kanagawa, Japan; 10National Cancer Center Hospital, Tokyo, Japan;11Osaka International Cancer Institute, Osaka, Japan
Invited Discussant: Peter Licht
Objective: The clinical T staging of lung cancer in the 8th edition of the UICC TNM staging system was determined according to the solid component size, excluding a ground glass opacity (GGO) component. However, there is no consensus on the measurements of solid component in many part-solid tumors due to the several radiologic findings in which the solid component size is quite difficult or impossible to measure. In contrast, we have reported a new and simple fact that presence of a GGO denotes a great influence on the favorable prognosis of non-small cell lung cancer (NSCLC), and a solid component is not considered for the prediction of long-term survival of NSCLC if the tumors show a GGO (Hattori A, Suzuki K, Takamochi K, et al. JTCVS2017;154:2102-10). Hence, we performed a validation study to confirm the prognostic importance of the presence of a GGO based on the long-term follow up data of JCOG0201 which was a prospective study to predict pathological non-invasive lung adenocarcinoma in Japan.
Methods: Among the 811 patients registered in JCOG0201, 671 were eligible by an appropriate study monitoring and an adequate central review of thin-section computed tomography (CT). Registered c-stage IA NSCLC was less than 30 mm in maximum tumor size, which was classified into GGO group or Solid group based on the presence of a GGO component on thin-section CT. Based on the solid component size, T staging was reassigned in accordance with the 8th edition TNM staging system of the c-T category. Clinicopathological characteristics were compared between the two study groups. Overall survivals (OS) were estimated using the Kaplan-Meier method.
Results: Of the cases, 432 (64%) were GGO group, and 239 (36%) were Solid group with a median follow-up time of 10.1y. Solid group showed higher ratio of nodal metastasis (17% vs. 2%), pleural (32% vs. 7%), lymphatic (37% vs. 9%) or vascular invasion (36% vs. 7%) compared to those of the GGO group. Most of the GGO group revealed adenocarcinoma (99%), while several other histological types were found in the Solid group including 8% of non-adenocarcinoma. The 5y-OS was significantly different between GGO and Solid group in c-stage IA NSCLC (95.1% vs. 81.1%, log-rank test p<0.001). Furthermore, the 5y-OS were excellent despite the solid component size among the GGO group (c-T1a or less (n=215): 97.2%, c-T1b (n=181): 93.4%, c-T1c (n=36): 91.7%, Fig. 1a). In contrast, the prognostic impact of the tumor size was definitive in the Solid group (c-T1a (n=8): 87.5%, c-T1b (n=136): 85.9%, c-T1c (n=95): 73.7%, Fig. 1b).
Conclusions:The favorable prognostic impact of the presence of a GGO component was confirmed in the JCOG0201 dataset. Lung cancer with a GGO component is considered as a different oncological category from the solid tumor without a GGO. Hence, the presence or absence of a GGO should be considered as an important T parameter in the next clinical T classification.
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