GGO-dominant lung tumors have excellent prognosis

By Joanna Lyford, Senior medwireNews Reporter

Ground glass opacity (GGO)-dominant clinical stage IA lung adenocarcinoma is a low-grade malignancy with an “excellent” prognosis, Japanese researchers believe.

They found that 3-year recurrence-free survival was over 95% in patients with these tumors who were managed with sublobar resection – either wedge resection or segmentectomy.

“We speculate that GGO-dominant tumors indicate a uniform group exhibiting less tumor invasiveness and favorable prognosis,” write Morihito Okada (Hiroshima University, Japan) and co-authors in Chest.

Okada’s group conducted a retrospective analysis of 610 consecutive patients who underwent curative R0 resection for GGO-dominant clinical T1N0M0 stage IA lung adenocarcinoma.

Preoperative staging was done using high-resolution computed tomography (CT) and F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). Patients showing lymph node metastasis also received four cycles of platinum-based chemotherapy.

The patients’ average age was 65 years, 39.3% were male, and the maximum standardized uptake value was 0.9. In all, 37.7% of patients were treated with lobectomy, 23.4% underwent segmentectomy, and 38.9% had a wedge resection. Just two (0.8%) patients were found to have lymph node metastasis.

No patient died within 30 days of surgery. During a median follow-up period of 42 months, two patients had a recurrence: one developed peritoneal recurrence at 23 months after left S6 segmentectomy and one developed brain metastasis at 24 months after right middle lobectomy.

Patient outcomes did not differ by type of surgical procedure, the researchers note. Three-year recurrence-free survival was 96.4% with lobectomy, 96.1% with segmentectomy, and 98.7% with resection, while 3-year overall survival was 97.6%, 98.2%, and 98.7%, respectively.

These excellent outcomes were seen in patients with either T1a or T1b tumors. No preoperative variable was found to be independently associated with outcomes, however.

Okada and colleagues conclude that sublobar resection appears to offer local control of GGO-dominant tumors and is an appropriate surgical approach for this low-grade malignancy.

Specifically, they recommend that T1a tumors should be managed with wedge resection and T1b tumors with segmentectomy; however, they add: “Regarding T1b tumors, a prospective study of segmentectomy for GGO-dominant tumors is warranted.”

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