Surgical management and outcomes of multifocal ground-glass opacities in elderly patients

doi:10.3877/cma.j.issn.2095-8773.2016.04.01

Abstract

Abstract:

Objective

To discuss the surgical management and outcomes of multifocal ground-glass opacities (GGO) in elderly patients.

Methods

The clinical data of 78 elderly patients with multifocal GGO treated in Department of Thoracic Surgery, Huadong Hospital affiliated to Fudan University between January 2011 and January 2013 were retrospectively analyzed. According to the consolidation proportion on preoperative imaging findings, 34 patients were classified into GGO group (GGO-dominant lesion, C/T≤0.5), and 44 in SN-group (solid-dominant lesion, C/T>0.5). The effects of different surgical procedures on survival of patients in two groups were compared, and the factors related to outcomes were analyzed.

Results

The 3-year survival in sublobar resection group (n=37) was 87.3%, which was not significantly different from that in standard lobectomy group (n=33, 85.6%)(χ²=1.285, P>0.05). The 3-year survival in GGO group was significantly higher than that in SN group (97.1% vs 79.5%, χ²=8.490, P<0.05). The 3-year survival in T1a group was significantly higher than that in T1b group(95.3% vs 77.1%, χ²=0.660, P<0.05). Multivariate analysis demonstrated that nodular diameter and C/T ratio were closely related to prognosis (P<0.05).

Conclusions

Sublobar resection for multifocal GGO is considered to be an appropriate treatment in the elderly patients as this procedure provides an equivalent long-term outcome in comparison with lobectomy. The nodular diameter and C/T ratio are associated with prognosis.

Key words: Lung cancer, Ground-glass opacities, Subsolid nodules, Elder

Yun Wu, Fanzheng Luy, Xiaoyong Shen, Zhenghong Zhu, Wen Gao. Surgical management and outcomes of multifocal ground-glass opacities in elderly patients[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(04): 193-198.

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References 18

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指标		GGO组(34例)	SN组(44例)	统计值	P值
中位年龄(岁)		73(70～82)	74(70～83)	Z＝1.018	0.785
性别(例)		?	?	χ²＝0.935	0.618
?	男性	15	19	?	?
?	女性	19	25	?	?
吸烟史(例)		?	?	χ²＝1.153	0.179
?	有	13	17	?	?
?	无	21	27	?	?
既往恶性肿瘤史(例)		?	?	χ²＝1.089	0.248
?	有	6	7	?	?
?	无	28	37	?	?
术前合并症(例)		?	?	χ²＝1.247	0.067
?	有	11	14	?	?
?	无	23	30	?	?
临床T分期(例)		?	?	χ²＝0.736	0.398
?	T1a(≤2 cm)	24	19	?	?
?	T1b(2 cm≤T≤3 cm)	10	25	?	?
结节数(中位数/例)		3(2～7)	2(2～5)	χ²＝2.329	0.389
?	2枚	15	14	?	?
?	3枚	11	25	?	?
?	≥4枚	8	5	?	?
结节直径(mm，±s)		13.2±5.8	21.3±9.2	t＝12.434	0.027
结节分布(例)		?	?	χ²＝1.181	0.236
?	同侧	16	19	?	?
?	对侧	18	25	?	?
术后病理(例)		?	?	χ²＝2.798	0.357
?	多发腺癌	34	35	?	?
?	多发鳞癌	0	6	?	?
?	其他肿瘤	0	3	?	?

指标		GGO组(34例)	SN组(44例)	统计值	P值
中位年龄(岁)		73(70～82)	74(70～83)	Z＝1.018	0.785
性别(例)		?	?	χ²＝0.935	0.618
?	男性	15	19	?	?
?	女性	19	25	?	?
吸烟史(例)		?	?	χ²＝1.153	0.179
?	有	13	17	?	?
?	无	21	27	?	?
既往恶性肿瘤史(例)		?	?	χ²＝1.089	0.248
?	有	6	7	?	?
?	无	28	37	?	?
术前合并症(例)		?	?	χ²＝1.247	0.067
?	有	11	14	?	?
?	无	23	30	?	?
临床T分期(例)		?	?	χ²＝0.736	0.398
?	T1a(≤2 cm)	24	19	?	?
?	T1b(2 cm≤T≤3 cm)	10	25	?	?
结节数(中位数/例)		3(2～7)	2(2～5)	χ²＝2.329	0.389
?	2枚	15	14	?	?
?	3枚	11	25	?	?
?	≥4枚	8	5	?	?
结节直径(mm，±s)		13.2±5.8	21.3±9.2	t＝12.434	0.027
结节分布(例)		?	?	χ²＝1.181	0.236
?	同侧	16	19	?	?
?	对侧	18	25	?	?
术后病理(例)		?	?	χ²＝2.798	0.357
?	多发腺癌	34	35	?	?
?	多发鳞癌	0	6	?	?
?	其他肿瘤	0	3	?	?

手术资料			病例数(%)
切除所有结节			?
?	是		29(37.2)
?	否		49(62.8)
结节位置			?
?	结节位于同侧		35(44.9)
?	?	亚肺叶切除	13
?	?	肺叶切除	20
?	?	肺叶切除＋亚肺叶切除	2
?	结节位于不同侧		43(55.1)
单侧切除			22
?	一侧亚肺叶切除		11
?	一侧肺叶切除		9
?	一侧肺叶切除＋亚肺叶切除		2
双侧切除			21
?	双侧分期亚肺叶		13
?	双侧分期肺叶		4
?	双侧分期肺叶＋亚肺叶(前/后)		4

手术资料			病例数(%)
切除所有结节			?
?	是		29(37.2)
?	否		49(62.8)
结节位置			?
?	结节位于同侧		35(44.9)
?	?	亚肺叶切除	13
?	?	肺叶切除	20
?	?	肺叶切除＋亚肺叶切除	2
?	结节位于不同侧		43(55.1)
单侧切除			22
?	一侧亚肺叶切除		11
?	一侧肺叶切除		9
?	一侧肺叶切除＋亚肺叶切除		2
双侧切除			21
?	双侧分期亚肺叶		13
?	双侧分期肺叶		4
?	双侧分期肺叶＋亚肺叶(前/后)		4

病理指标			GGO组(34例)	SN组(44例)	χ²值	P值
病理类型(例)			?	?	0.597	0.283
?	腺癌		34	44	?	?
?	?	包括AIS	8	7	?	?
?	?	包括MIA	17	11	?	?
?	?	包括IAC	19	23	?	?
鳞癌	?		0	3	?	?
病理分期(例)			?	?	2.597	0.007
?	ⅠA期		29	18	?	?
?	ⅠB期		5	17	?	?
?	ⅡA期及以上分期		0	9	?	?
淋巴结累及(例)			?	?	1.278	0.055
?	无		34	39	?	?
?	有		0	5	?	?
手术方式			?	0.743	?	0.067
?	亚肺叶切除		23	14	?	?
?	肺叶切除		8	25	?	?
?	肺叶＋亚肺叶切除		3	5	?	?
淋巴结清扫			?	?	0.489	0.117
?	系统性淋巴结清扫		4	28	?	?
?	淋巴结采样		9 (38)^①	16	?	?
?	不清扫		8 (33)^①	0	?	?
EGFR突变(例)			?	0.396	?	0.208
?	突变		18	12	?	?
?	野生型		13	27	?	?

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