Importance of Ground-Glass Opacity in Long-Term Survivors of Lung Adenocarcinoma: A Leopard Cannot Change Its Spots
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EDITORIAL – THORACIC ONCOLOGY
Importance of Ground-Glass Opacity in Long-Term Survivors of Lung Adenocarcinoma: A Leopard Cannot Change Its Spots Takashi Ohtsuka, MD, PhD Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
In the article by Shigefuku and colleagues,1 the authors investigated factors associated with overall survival (OS) and cancer-specific survival (CSS) in lung adenocarcinoma patients who remained free from recurrence for more than 5 years after complete resection. Survival analyses showed that sex, smoking history, whole tumor size, pathological node status, pathological stage, blood vessel invasion, lymphatic permeation, visceral pleural invasion, and absence of ground-glass opacity (GGO) components were significant factors associated with OS and CSS, while multivariate analysis showed that sex, pathological node status, and absence of GGO components were significant independent factors associated with OS and CSS. In pathological stage I patients, absence of GGO components was significantly associated with poor OS and CSS. The results are interesting, and the main finding of this study is that the absence of GGO components increases the recurrence risk of lung adenocarcinoma 5 years after complete resection. Several studies have shown that GGO components in the tumor are associated with a favorable prognosis. The GGO component on chest computed tomography (CT) is associated with the indolence of lung cancer. In the 8th edition of the TNM classification, the presence of the GGO component on chest CT is regarded as noninvasive, and is excluded while measuring the preoperative tumor
Ó Society of Surgical Oncology 2020 First Received: 26 August 2020 Accepted: 30 August 2020 T. Ohtsuka, MD, PhD e-mail: [email protected]
diameter.2 However, after complete resection of the lung adenocarcinoma, the effect of GGO on long-term prognosis has not been determined. For a long time, 5-year disease-free survival after complete resection remained the milestone in curing lung cancer. A few studies have investigated postoperative longterm survival in lung cancer patients who underwent complete resection. Maeda et al. reported that lung cancer recurred in 10.6% of patients at 5 years after these patients underwent resection, and local and distant metastases developed in 4.6% and 6.0% of patients, respectively.3 In the aforementioned study conducted by Shigefuku et al., the recurrence rates beyond 5 years were 1.5% and 5.8% in patients with and without GGO, respectively. The former rate was slightly better than the previously reported rate, however this may be due to the high percentage of patients with GGO included in this study. Some drawbacks exist in the study. For instance, the ratio of GGO has not been considered. In a recent study conducted by the Japan Clinical Oncology Group Lung Cancer Surgical Study Group, consolidation/tumor ratio B 0.5, which is identical to 50% of GGOs in the tumor, showed excellent prognosis.4 The GGO ratio could be importan
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