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Morihito Okada
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MA06 - Challenges in the Treatment of Early Stage NSCLC (ID 124)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:Florentino Hernando-Trancho, Ayten Kayi Cangir
- Coordinates: 9/08/2019, 13:30 - 15:00, Colorado Springs (1994)
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MA06.06 - A Phase III Study of Adjuvant Chemotherapy in Patients with Completely Resected, Node-Negative Non-Small Cell Lung Cancer (Now Available) (ID 285)
13:30 - 15:00 | Author(s): Morihito Okada
- Abstract
- Presentation
Background
Post-operative UFT (tegafur/uracil) has been shown to prolong survival of Japanese patients with completely resected, p-stage I (T1> 2 cm) non-small cell lung cancer (NSCLC). This trial, the Japan Clinical Oncology Group (JCOG) 0707, aimed at estimating the efficacy of S-1 (tegafur/gimeracil/oteracil) compared to UFT as adjuvant therapy in this population.
Method
Eligible patients had received complete resection with lymph node dissection for p-stage I (T1-2N0M0, T1> 2 cm, by 5thEdition UICC TNM) NSCLC, within 56 days of enrollment. Patients were randomized to receive: oral UFT 250mg/m2/day for 2 years (Arm A), or oral S-1 80mg/m2/day for 2 weeks and 1 week rest, for 1 year (Arm B). The initial primary endpoint was overall survival (OS). Based upon the monitoring in Jun. 2013, which showed the combined OS of the 2 arms better than expected (4-year OS of 91.6% vs. presumed 5-year OS of 70-76.5%), it was judged to be underpowered. The study protocol was amended so that the primary endpoint is relapse-free survival (RFS). With the calculated sample size of 960, this study would detect the superiority of Arm B over Arm A with power 80% and one-sided type I error of 0.05, assuming the 5-year RFS of 75% in Arm A and the hazard ratio of 0.75.
Result
From Nov. 2008 to Dec. 2013, 963 patients were enrolled (Arm A : 482, Arm B : 481): median age 66 (range: 33 to 80), male 58%, adenocarcinoma 80%, p-T1/T2 46%/54%. Only 2 received pneumonectomy. >Grade 3 toxicities (hematologic/nonhematologic) were observed in 15.9 (1.5/14.7) % in Arm A, and in 14.9 (3.6/12.1) % in Arm B, respectively. 60.0% of the patients in Arm A and 54.7% of them in Arm B completed the protocol treatment (p=0.10). There were 4 cases of deaths during protocol treatment, probably of cardio-vascular origin, with 1 in Arm A and 3 in Arm B. At the data cut-off of Dec. 2018, the hazard ratio (HR, Arm B vs. Arm A) of RFS was 1.06 (95% confidence interval (C.I.): 0.82-1.36), showing no superiority of S-1 over UFT. The HR of OS was 1.10 (95% C.I.: 0.81-1.50). The 5-year RFS/OS rates were 79.4%/88.8% in Arm A and 79.5%/89.7% in Arm B, respectively. Pre-specified subset analyses for gender, age, smoking, stage, tumor side, lymph node dissection area, pleural invasion and histology revealed no remarkable results; S-1 arm was not superior to UFT arm in each analysis. Of the 77 and 85 OS events for Arm A/Arm B, 45 each (58%/53%, respectively) were due to the NSCLC. During the follow-up period, secondary malignancy was observed in 85 (17.8%) and 84 (17.8%) in Arm A and Arm B, respectively.
Conclusion
Post-operative adjuvant therapy with oral S-1 was not superior to that with UFT in stage I (T>2 cm) NSCLC after complete resection. UFT remains standard in this population. Future investigation should incorporate identification of high-risk population for recurrence, since survival of each arm was so good with substantial number of OS events due to other causes of deaths in this trial.
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MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:Fabrizio Bianchi, Marcelo Sanchez
- Coordinates: 9/08/2019, 15:15 - 16:45, Dublin (1997)
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MA10.11 - Sensitivity and Optimal Clinicopathological Features of Genetic Targeted Liquid Biopsy in pN0M0 Lung Adenocarcinoma (Now Available) (ID 788)
15:15 - 16:45 | Author(s): Morihito Okada
- Abstract
- Presentation
Background
Liquid biopsy for diagnosis of early-stage lung cancer is still challenging. The optimal marker and methodology has not been established. In Asia, almost 40-50% of lung adenocarcinomas harbor the EGFR mutation and L858R is a representative of a somatic EGFR mutation. We evaluated the usefulness of the EGFR somatic mutation in liquid biopsy using droplet digital PCR (ddPCR), which is a sensitivity device to detect several types of genetic mutations.
Method
We examined weather L858R could be detected from preoperative ctDNA by ddPCR. Cases without EGFR mutation (wild type) were utilized as negative control. All involved cases underwent surgical resection after preoperative HRCT and PET-CT. Serum for ctDNA extraction was collected before the operation. L858R in the primary site was confirmed by resected surgical specimen. Clinicopathological features (e.g.: whole and invasive tumor size on HRCT, SUV max on PET-CT, histological subtype) were also explored for an optimal liquid biopsy candidate.
Result
Forty-five pN0M0 lung adenocarcinoma patients harboring L858R were enrolled. Twenty-one and 24 cases showed part-solid and pure solid appearance on HRCT, respectively. Median whole and invasive tumor size on HRCT was 21 and 19 mm, respectively. 91.1% (41/45) cases were clinical stage IA1-IB and 97.8% (44/45) cases were pathological stage IA1-IB. In wild type cases, positive droplet for L858R was almost completely undetectable. Whereas, L858R was significantly detected in 7 EGFR mutant cases (sensitivity is 15.56%, 7/45). Among 7 positive cases, 6 cases showed pure solid appearance in preoperative HRCT. Except for pure solid appearance, there was no significant features related to the positive result. If cases are limited to pure solid appearance, 25.0% (6/24) of cases could be diagnosed by liquid biopsy. Even small-sized tumors (1.1 cm in diameter) or tumors with slight accumulation on PET-CT (SUV max 0.5) could be detected if it showed pure solid appearance on HRCT.
Conclusion
L858R can be a definitive marker for liquid biopsy using ddPCR in pN0M0 lung adenocarcinoma. 15.56% (7/45) of cases were diagnosed in pN0M0 cases. Limited to pure solid tumor, 25.0% (6/24) could be detected. Liquid biopsy can be a useful diagnostic option, especially for tumors with pure solid appearance.
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P1.13 - Staging (ID 181)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Staging
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.13-13 - High-Risk Clinical Stage I Non-Small Cell Lung Cancer Based on High-Resolution Computed Tomography Findings (ID 743)
09:45 - 18:00 | Author(s): Morihito Okada
- Abstract
Background
Perioperative systemic therapy for stage I non-small cell lung cancer (NSCLC) has not been established. The purpose of this study was to identify the high-risk patients for recurrence in clinical stage I NSCLC who were potentially candidates for systemic therapy in addition to standard lobectomy.
Method
After excluding patients who underwent sublobar resection, 397 patients with clinical stage I NSCLC who underwent lobectomy with systematic lymph node dissection between April 2007 and March 2016 were analyzed. Solid component size on high-resolution computed tomography (HRCT) was used as tumor size on the basis of the 8th edition of TNM classification. Relapse-free survival (RFS) was estimated using Kaplan-Meier method, and multivariable Cox proportional hazards model was used to identify independent prognostic factors for RFS.
Result
Five-year RFS of all patients was 73.6%. Multivariable Cox analysis revealed that age (hazard ratio [HR], 1.04 (95% confidence interval [CI], 1.01– 1.06; P = 0.005), solid component size (mm) (HR, 1.06 (95% CI, 1.04–1.09; P <0.001), and pure solid type (HR, 1.79 (95% CI, 1.10–2.91; P = 0.02) were independent prognostic factors for RFS. When patients were divided into high-risk group for recurrence (solid component size of >2 cm or pure solid type) and low-risk group (solid component size of <2 cm and part solid type), there was a significant difference in RFS between high-risk group (n = 298; 5-y RFS, 65.0%) and low-risk group (n = 129; 5-y RFS, 91.0%; P <0.001). Lymphatic invasion (29.5% vs. 9.3%, P <0.001), vascular invasion (36.6% vs. 7.8%, P <0.001), pleural invasion (28.4% vs. 9.3%, P <0.001), and lymph node metastasis (17.9% vs. 1.6%, P <0.001) were more frequent in high-risk group than in low-risk group.
Conclusion
In clinical stage I NSCLC, patients with solid component size of >2 cm or pure solid type on HRCT were high-risk group for recurrence. These patients may be potential candidates for systemic therapy such as neoadjuvant immunotherapy.
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P1.17 - Treatment of Early Stage/Localized Disease (ID 188)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 4
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-01 - Surgical Outcome of Early Stage Lung Cancer Related vs Unrelated to Honeycomb Lesions with Interstitial Pneumonia (Now Available) (ID 45)
09:45 - 18:00 | Author(s): Morihito Okada
- Abstract
Background
Lung cancer complicated with idiopathic interstitial pneumonia (IIPs) is known to lead to worse prognosis. Recently, it has been reported that the pathological characteristics differ between the lung cancer arising the honeycomb lesion of interstitial pneumonia (H-IIP group) and arising in other lesions (NH-IIP group). In this study, we aimed to assess the clinicopathologic outcome of resected lung cancer in each group.
Method
From a single center database of 1065 consecutive patients with clinical stage IA non-small cell lung cancer who had undergone preoperative high-resolution computed tomography and F-18-fluorodeoxyglucose positron emission tomography/ computed tomography, 112 patients with a radiologically determined IIP (H-IIPs; n=33, NH-IIP; n=79) were included in this study. Examination of clinicopathological outcomes were performed comparing each group.
Result
Median solid tumor size of each group were similar (18.4mm vs 18.6mm p=0.928), but median ground gloss opacity rate is significantly higher in NH-IIP group (6.7% vs 21.4% p=0.042). In the histopathological types, H-IIP group had significantly high rate of squamous cell carcinoma (45.5% vs 27.9%) and NH-IIP group had adenocarcinoma (27.3% vs 57.0%). As in previous reports, the proportion of EGFR mutation in adenocarcinomas tended to be high in NH-IIPs and also the high proportion of lepidic predominant. The disease-free survival (DFS) and overall survival (OS) were worse in patients of H-IIP group compared to NH-IIP group (DFS p=0.028, OS p=0.035). In a multivariate analysis, the H-IIP group and lower diffusing capacity for carbon of preoperative pulmonary functional test were significant worse predictors of OS and RFS (P < 0.001, respectively).
Conclusion
Lung cancer arising the honeycomb lesion of IIP had a great unfavorable impact on the prognosis of NSCLC, because of the worse pathological features.
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P1.17-08 - mRNA Expression Level of Receptor Tyrosine Kinases and Non-Receptor Tyrosine Kinases as a Recurrence Risk in Resected Adenocarcinoma of the Lung (ID 786)
09:45 - 18:00 | Author(s): Morihito Okada
- Abstract
Background
The profile of receptor tyrosine kinases (RTK) and non-receptor tyrosine kinases (non-RTK) is crucial for tumor genesis and therapeutic strategy in several types of cancer. We previously reported that elevated mRNA expression level of some RTKs/non-RTKs (AXL, CDCP1, STAT3, YAP1) were related to poorer prognosis in lung adenocarcinoma patients receiving EGFR-TKI. The prognostic impact of RTKs/non-RTKs is unclear in early-stage lung cancer. This study aims to explore the usefulness of RTK and non-RTK to detect the risk of recurrence in resected NSCLC, especially in EGFR mutant adenocarcinoma.
Method
We retrospectively collected pathologic N0-2 adenocarcinoma cases resected in Japanese and Spanish institutions. mRNA expression levels of RTK or non-RTK (STAT3, YAP1, AXL, CDCP1, MET, SHP2, and EGFR) in surgical specimens were evaluated and the impact of expression level on recurrence-free survival (RFS) was compared. The oncological significance on RTK or non-RTK was validated in vitro.
Result
Among enrolled 268 cases, 100 cases (37.3%) harbored EGFR mutation. Forty-five EGFR mutation positive cases recurred and cases with higher mRNA expression level of EGFR showed worse RFS. In addition, higher expression of CDCP1 or SHP2 indicated poorer RFS in EGFR mutation positive cases. In vitro, combination of SHP099 (SHP2 inhibitor) and osimertinib showed synergism in EGFR mutation positive cell line (Combination index was 0.62).
Conclusion
Higher expression of SHP2 and CDCP1 is potential risk of recurrence in EGFR mutant lung adenocarcinoma. The synergism of SHP2 inhibitor plus EGFR-TKI suggests that the expression level of SHP2 is involved in tumorigenesis and is a promising predictor for recurrence in EGFR mutant lung adenocarcinoma.
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P1.17-09 - Surgical Outcomes of Complex Versus Simple Segmentectomy for Stage I Non-Small Cell Lung Cancer (ID 803)
09:45 - 18:00 | Author(s): Morihito Okada
- Abstract
Background
As segmentectomy becomes widely used for lung cancer treatment, “complex segmentectomy,” which makes several, intricate intersegmental planes, remains controversial because of procedural complexity and risk of increased complications and incurability. Questions remain regarding mortality, morbidity, surgical margin, lymph nodes dissection, and postoperative pulmonary function. We evaluated operative and postoperative outcomes of complex compared to simple segmentectomy.
Method
We retrospectively reviewed clinical stage I lung cancer patients who could tolerate lobectomy and underwent complex or simple segmentectomy between April 2007 and March 2017. Clinicopathologic, operative, and postoperative results of the complex (n = 117) and simple (n = 92) segmentectomy groups were compared.
Result
No significant differences were detected in age, sex, comorbidities, preoperative pulmonary function, tumor histology, and size. Although only median operative time (180 vs. 143.5 minutes; P < 0.0001) was significantly longer in the complex group, 30-day mortality (0% vs. 0%), overall complications (24.8% vs. 22.8%), and prolonged air leakage (11.9% vs. 10.9%) were nearly equivalent between the two groups, respectively. The complex group showed comparable results in median surgical margin distance (16.0 vs. 17.5 mm) and number of dissected lymph nodes (6.0 vs. 7.0 nodes). Margin relapse occurred in two patients in the simple group but none occurred in the complex group. Both groups also showed similar postoperative pulmonary functions.
Conclusion
Complex segmentectomy is a safe option in the treatment of lung cancers with adequate operative outcomes.
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P1.17-13 - Next Generation Sequencing of the Circulating Small RNA from Serum Identifies Small RNA-Based Biomarker Panel for Stage I-II Lung Adenocarcinoma (ID 989)
09:45 - 18:00 | Author(s): Morihito Okada
- Abstract
Background
Circulating small RNAs have been reported as biomarkers for cancer diagnosis, including lung cancer. The purpose of this study is to identify the small RNA for the early detection of lung adenocarcinoma. In this study, we used next generation sequencing (NGS) in order to screen and validate expressions of the small RNAs between persons with and without adenocarcinoma and built the RNA-based biomarker panel.
Method
We used next generation sequencing in all phases (screening set, validation set, and the panel evaluation set) and researched micro RNAs(miR) and transfer RNA fragments(tRF) as small RNAs. We analyzed the RNAs from serum of 21 patients with adenocarcinoma and 20 healthy control for screening and assessed small RNAs from 22 patients with adenocarcinoma and 20 healthy control for validation. Regarding significantly upregulated and downregulated small RNAs, we built RNA-based biomarker panel and evaluated the panel with a different dataset (33 patients with adenocarcinoma and 27 healthy control).
Result
Based on screening and validation set, four miR and one tRF were upregulated. Tow miR and nine tRF were downregulated. An area under the curve value of each small RNA was 0.65 to 0.85. Among them, nine small RNA were adopted to the biomarker panel by using multiple regression analysis. In the cohort of screening and validation set, the panel showed a sensitivity of 93.0% and specificity of 88.0%, with an area under the curve value of 0.983, which was much larger than that of a single RNA. The panel was evaluated with a different dataset and showed a sensitivity of 90% and specificity of 74.1% when the threshold was 1.8.
Conclusion
In conclusion, we built the small RNA-based biomarker panel which included nine small RNA and our results showed the diagnostic efficacy of the panel. Further investigation is required to understand the cause for the expression change of each small RNA.
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P2.03 - Biology (ID 162)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Biology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.03-45 - PKCι-PAK1 Pathway Modulates Sensitivity to Therapy in EGFR, KRAS Mutant Adenocarcinoma and Squamous Cell Carcinoma (ID 789)
10:15 - 18:15 | Author(s): Morihito Okada
- Abstract
Background
p21-activated kinase 1 (PAK1) stimulates growth and metastasis in several types of tumors, including non-small cell lung cancer (NSCLC). Protein kinase C iota (PKCi) is an enzyme highly expressed in NSCLC that regulates PAK1 signaling. To understand intrinsic and acquired resistance to different MAPK signaling inhibitors, we explored PKCι-PAK1 signaling in EGFR/KRAS mutant adenocarcinoma or squamous cell carcinoma (SCC) cell lines by combination therapy using PAK1 inhibitor and PKCι inhibitor.
Method
Three lung cancer cell lines were used: HCC827 and H23 lung adenocarcinoma cells that carries EGFR and KRAS mutations, respectively, and H520 (PAK1 amplified squamous cell carcinoma). Cell viability assays and western blotting were applied to evaluate the effect of IPA-3 (PAK1 inhibitor) plus auranofin (PKCι inhibitor). Since IPA-3 is only for laboratory use, we explored alternative PAK-1 inhibitor and tested combination effect with auranofin.
Result
IPA-3 plus auranofin was highly synergistic (Combination index was less than 0.4) in EGFR mutant adenocarcinoma (HCC827), KRAS mutant adenocarcinoma (H23) and SCC with PAK1 amplification (H520) cell lines in MTT assay and colony forming assay. We revealed OTSSP167 (a MELK inhibitor in phase I/II trials) inhibits phosphorylated PAK1 and combination of OTSSP167 plus auranofin showed similar synergism in the 3 cell lines. The combination of auranofin with either IPA-3 or OTSSP167 ablated EGFR phosphorylation and downstream signaling pathways: ERK, AKT, STAT3, YAP1 and inhibited the expression of RTKs: AXL, MET, and CDCP1.
Conclusion
The combination of IPA-3 plus auranofin is promising treatment in different subclasses NSCLC with driver EGFR or KRAS mutations, as well as SCC with PAK1 amplification. OTSSP167 also works as PAK1 inhibitor. The therapeutic effect of PAK-1 inhibitor and PKCι inhibitor was validated using OTSSP167 plus auranofin.
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P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.14-52 - The Results from Plasma EGFR Mutation Analysis in NEJ026 Study (ID 602)
10:15 - 18:15 | Author(s): Morihito Okada
- Abstract
Background
EGFR mutation analysis of plasma circulating tumor DNA (ctDNA) has been reported to be useful to detect resistant mutations and to predict the efficacy of treatment. In NEJ026 study, we demonstrated the PFS of erlotinib plus bevacizumab (BE) treatment was significantly superior to the erlotinib alone (E) in NSCLC patients harboring EGFR mutation. Evaluation of plasma EGFR mutations included in NEJ026 study as preplanned analysis.
Method
At the time points of pretreated (P0), 6 weeks after study treatment started (P1), and confirmed progressive disease (P2), the plasma samples were collected from the patients enrolled to NEJ026 study. The number of enrolled patients were 112 in BE and 114 in E. Plasma ctDNA analysis for detection of the activating EGFR mutation and T790M mutation were performed by modified PNA-LNA PCR clamp method.
Result
The total numbers of collected plasma samples in BE and E were 108 (96.4%) and 107 (95.5%) at P0, 95 (84.8%) and 97 (86.6%) at P1, and 42 (37.5%) and 53 (47.3%) at P2, respectively. In eligible patients having EGFR activating mutation detected by cytohistological specimens, detection rate of plasma EGFR mutation at P0 was 68% (147/215). The detection ratio of T790M mutation at P2 were similar in both arms: 8 (19.0%) in BE and 11 (20.8%) in E. By detection pattern of activating EGFR mutation, PFS was evaluated among three groups: type A (P0 (-),P1 (-)), type B (P0 (+), P1(-)), and type C (P0 (+), P1(+)). Type A achieved the best response to both TKI [Type A BE: 18.1 M (n = 32, 95% CI, 11.5 to upper limit not reached(NR)), E: 16.7 M (n = 26, 95% CI, 11.2 to NR )]. Type B also had better PFS to TKI and BE is more favorable effect than E compared to other types [type B BE: 15.5 M (n = 48, 95% CI, 12.4 to 23.3), E: 11.1 M (n = 57, 95% CI, 8.5 to 13.7)]. Type C showed worse response to both treatment [type C BE: 6.0M. (n = 12, 95% CI 2.6 to NR), E: 4.3 M (n = 10, 95% CI, 2.8 to 20.2)]. BE had better PFS in all types.
Conclusion
Frequency of T790M in P2 was similar among BE and E. When patients still had detectable activating EGFR mutation in plasma ctDNA after treatment for 6 weeks, you should consider that they might have poor response to both BE and E.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-01 - Analysis of Clinical Features and Prognosis of Non-Small Cell Lung Cancer Exceeding 30 mm Depending on the Ground Glass Opacity (GGO) Ratio (ID 230)
10:15 - 18:15 | Author(s): Morihito Okada
- Abstract
Background
The ground glass opacity (GGO) ratio is associated with the prognosis of small (<30 mm) non-small cell lung cancer (NSCLC). However, the clinical features, especially the GGO ratio, and prognosis of NSCLC exceeding 30 mm are not well known. Therefore, this study aimed to determine the characteristics of patients with NSCLC exceeding 30 mm and analyze the clinical significance of the GGO ratio on prognosis.
Method
Totally, 271 patients with NSCLC tumors exceeding 30 mm on preoperative computed tomography scans and who underwent complete resection at our institution between January 2007 and December 2017 were included. The patients were divided into three groups based on the GGO ratio: pure solid tumors, GGO ratio 0–40%, and GGO ratio ≥40%. The cut-off value of 40% was determined based on the recurrence rate for each GGO ratio group. Clinical feature and prognosis of each group were analyzed.
Result
Of the included patients, 147 (54%) had pure solid nodule, 67 (25%) had nodules with a GGO ratio 0–40%, and 57 (21%) had nodules with a GGO ratio ≥40%. Among the patients with a GGO ratio ≥40%, 10 underwent limited resection (segmentectomy in 9 patients and wedge resection in 1); no patients experienced recurrence. Among the 147 patients with pure solid nodules, 47 (32%) experienced recurrence. Among the 67 and 57 patients with GGO ratio 0–40% and GGO ratio ≥40%, 16 (24%) and 2 (4%), respectively, experienced recurrence. The 3-year recurrence-free survival (RFS) rate was significantly shorter in patients with pure solid nodules (60.5%) than in patients with GGO ratio 0–40% (74.0%; p=0.010) and GGO ratio ≥40% ( 93.6%; p<0.001). Moreover, RFS was significantly shorter in patients with GGO ratio 0–40% than in patients with GGO ratio ≥40% (p=0.009). Similar results were observed for overall survival (OS). The 3-year OS rate was significantly shorter in patients with pure solid nodules (79.1%) than in patients with GGO ratio 0–40% (88.2%; p=0.046) and GGO ratio ≥40% (95.6%; p<0.001). Moreover, OS was shorter in patients with GGO ratio 0–40% than in patients with GGO ratio ≥40% with marginal significance (p=0.052).
Conclusion
A pure solid nodule was a major component among NSCLC tumors exceeding 30 mm. Among such patients, as the GGO ratio decreased, the recurrence rate increased. A GGO ratio of 40% is the appropriate cut-off value, and patients with GGO ratio ≥40% have better prognosis compared to patients with GGO ratio <40% or pure solid nodules. The prognosis of patients with GGO ratio ≥40% who undergo limited resection may be similar to that of patients undergoing lobectomy, the standard operation procedure.
