Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces Woohyun Jung, MD1, Sukki Cho, MD, PhD1,2, Sungwon Yum, BS1, Jin-Haeng Chung, MD, PhD3,4, Kyung Won Lee, MD, PhD5,6, Kwhanmien Kim, MD, PhD1,2, Choon Taek Lee, MD, PhD7,8, and Sanghoon Jheon, MD, PhD1,2 1
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; 3Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; 4Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea; 5Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; 6Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; 7Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; 8Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
ABSTRACT Objectives. Subsolid lung adenocarcinoma with cystic airspaces (LACA) is a unique manifestation of lung cancer. This study was conducted to establish a radiologic disease progression model of LACA and to explore its association with the clinical course and clinicopathologic features of LACA. Materials and Methods. Sixty patients with LACA who underwent surgery at our center between 2004 and 2017 were retrospectively reviewed. The morphological changes of LACA over time on 98 serial computed tomography scans from 27 of 60 patients were tracked to establish a radiologic disease progression model. Associations between this model and the clinicopathologic characteristics of LACA were investigated. Results. The following stepwise progression model of LACA was developed: in phase I, cystic airspaces (CAs) appear in the middle of non-solid nodules; in phase II, the
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08508-4) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 4 November 2019 S. Cho, MD, PhD e-mail: [email protected]
CAs grow; in phase III, a solid component appears on the border of the CAs; and in phase IV, the solid component gradually surrounds the CAs and becomes thicker, and the CAs shrink. In total, 10 (17%), 33 (55%), and 17 (28%) LACA patients were classified as belonging to phases II, III, and IV at the time of surgery, respectively. More advanced phases were associated with higher pathologic T and N staging, lymphovascular invasion, visceral pleural invasion, spread through air spaces, and solid/micropapillary subtype. In the multivariate analysis, our model demonstrated a good discrimination capability for cancer recurrence risk. Conclusions. The stepwise disease progres
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