Pathology results and prognosis in patients with ground glass opacity-predominant lung adenocarcinoma: immediate surgery versus surgery after surveillance

Background Advances in imaging technology have led to the detection of more ground glass nodule (GGN) in lung. However, the management of GGN remains controversial.

Objective To analyze the pathology results and prognosis of ground glass opacity-predominant lung adenocarcinoma in patients undergoing surgery after detection and in patients undergoing surgery after more than or equal to one year surveillance, and investigate the feasibility of surveillance for ground glass opacity-predominant lung adenocarcinoma.

Methods From January 2013 to August 2017, patients undergoing surgery for ground glass opacity-predominant lung adenocarcinoma including pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR)≤0.5 in the First Medical Center of Chinese PLA General Hospital were selected. The patients were divided into surgery after detection group (SD group) and surgery after more than or equal to one year surveillance group (SS group), and the SS group was further divided into growth group and non-growth group. Propensity score matching (PSM) was used to adjust for confounding variables. The follow-up ended on August 31, 2022. Pathological outcomes and prognosis were compared between the SD group and the SS group.

Results A total of 284 GGN were included, 214 GGN were in the SD group and 70 GGN in the SS group. Another 120 patients (60 cases in the SD group and 60 cases in the SS group) were included after the propensity score matching. After PSM, there were no significant differences in pathological type and pathological subtype between the SD group and the SS group (P=0.523; P=0.290, respectively). No lymph node metastasis was found in either group. The 5-year OS and 5-year RFS were 100% in both groups. There were no significant differences in pathological type (P=0.176) and pathological subtype(P=0.858) between the growth group and the non-growth group.

Conclusion The pathological results and prognosis of the SD group and the SS group are similar. Active surveillance may be a feasible management approach for ground glass opacity-predominant lung adenocarcinoma.