Diagnosis and treatment of 281 elderly patients with pulmonary ground-glass opacity: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SU Lei ¹ , ZHANG Yi ¹ , GAO Yan ² , WEI Bing ³ , WANG Tengteng ¹ , LI Yuanbo ¹ , QIAN Kun ¹ , ZHANG Peilong ¹ , WANG Leiming ⁴ ,  WEI Xiuqin ⁵

1. Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
2. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
3. Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
4. Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
5. Endoscopic Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, 100144, P. R. China;

Corresponding author：

WEI Xiuqin, Email: weixq8888@163.com

Keywords：

Elderly patients; ground-glass opacity; imaging features; postoperative pathology

DOI：

10.7507/1007-4848.202308044

Video：

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Objective To explore the diagnosis and treatment strategies for elderly patients with ground-glass opacity (GGO). Methods The imaging features and postoperative pathological findings of the elderly patients with pulmonary GGO receiving surgery in our hospital from 2017 to 2019 were retrospectively analyzed. The patients were divided into an elderly patient group and a non-elderly patient group based on their age. Results Finally 575 patients were included in the study. There were 281 elderly patients, including 83 males and 198 females, with an average age of (67.0±5.3) years. There were 294 non-elderly patients, including 88 males and 206 females, with an average age of (49.1±7.3) years. Compared with the non-elderly patients, elderly GGO patients showed the following distinct clinical features: long observation time for lesions (P=0.001), high proportion of rough edges of GGO (P<0.001), significant pleural signs (P＜0.001) and bronchial signs (P＜0.001), and high proportion of type Ⅱ-Ⅳ GGO (P<0.001), lobectomy type (P=0.013), and invasive lesions reported in postoperative pathology (P<0.001). There was no statistical difference in the average hospital stay between the two groups (P=0.106). Multivariate logistic regression analysis showed that GGO diameter and GGO type were the main factors affecting the operation. Observation time, GGO diameter, GGO type and pleural signs were the main influencing factors for postoperative pathological infiltrative lesions. The cut-off value of GGO diameter in predicting infiltrating lesions was 10.5 mm in the elderly patients group. Conclusion The size and type of GGO are important factors in predicting invasive lesions and selecting surgical methods. Elderly patients with radiographic manifestations of type Ⅱ-Ⅳ GGO lesions with a diameter greater than 10.5 mm should be closely followed up.

Citation： SU Lei, ZHANG Yi, GAO Yan, WEI Bing, WANG Tengteng, LI Yuanbo, QIAN Kun, ZHANG Peilong, WANG Leiming, WEI Xiuqin. Diagnosis and treatment of 281 elderly patients with pulmonary ground-glass opacity: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(1): 94-99. doi: 10.7507/1007-4848.202308044 Copy

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3.	Sawada S, Yamashita N, Sugimoto R, et al. Long-term outcomes of patients with ground-glass opacities detected using CT scanning. Chest, 2017, 151(2): 308-315.
4.	苏雷, 张毅, 李元博, 等. 20~30 mm磨玻璃肺结节的影像学特征及术后病理分析. 医学研究杂志, 2020, 49(11): 54-59.Su L, Zhang Y, Li YB, et al. Analysis of the imaging characteristics and postoperative pathology of 20 to 30 mm ground glass opacity lung nodules. J Med Res, 2020, 49(11): 54-59.
5.	Su L, Li Y, Wang T, et al. Synchronous multiple primary lung cancers with shared EGFR mutation but differential imaging findings and pathological subtypes: A case report. Respir Med Case Rep, 2020, 31: 101244.
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7.	Kakinuma R, Noguchi M, Ashizawa K, et al. Natural history of pulmonary subsolid nodules: A prospective multicenter study. J Thorac Oncol, 2016, 11(7): 1012-1028.
8.	Pilleron S, Soto-Perez-de-Celis E, Vignat J, et al. Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int J Cancer, 2021, 148(3): 601-608.
9.	Li Y, Hu S, Xie J, et al. Effects of surgery on survival of elderly patients with stageⅠ small-cell lung cancer: Analysis of the SEER database. J Cancer Res Clin Oncol, 2019, 145(9): 2397-2404.
10.	苏雷, 张毅, 高艳, 等. 单孔胸腔镜治疗281例老年肺磨玻璃结节患者分析. 医学研究杂志, 2021, 50(9): 27-31, 37.Su L, Zhang Y, Gao Y, et al. Analysis of 281 elderly patients with pulmonary ground-glass opacity treatment by single-port thoracoscopy. J Med Res, 2021, 50(9): 27-31, 37.
11.	Blanco R, Maestu I, de la Torre MG, et al. A review of the management of elderly patients with non-small-cell lung cancer. Ann Oncol, 2015, 26(3): 451-463.
12.	Suzuki S, Sakurai H, Yotsukura M, et al. Clinical features of ground glass opacity-dominant lung cancer exceeding 3. 0 cm in the whole tumor size. Ann Thorac Surg, 2018, 105(5): 1499-1506.
13.	Huang C, Wang C, Wang Y, et al. The prognostic significance of pure ground glass opacities in lung cancer computed tomographic images. J Cancer, 2019, 10(27): 6888-6895.
14.	Honda Y, Oka S, Chikaishi Y, et al. Mediastinal lymph node metastases in lung cancer presenting as pure ground-glass nodules: A surgical case report. Int J Surg Case Rep, 2020, 70: 5-7.
15.	Zaatar M, Stork T, Valdivia D, et al. Minimal-invasive approach reduces cardiopulmonary complications in elderly after lung cancer surgery. J Thorac Dis, 2020, 12(5): 2372-2379.
16.	Kuhn E, Morbini P, Cancellieri A, et al. Adenocarcinoma classification: Patterns and prognosis. Pathologica, 2018, 110(1): 5-11.
17.	Thomas PA, Couderc AL, Boulate D, et al. Early-stage non-small cell lung cancer beyond life expectancy: Still not too old for surgery? Lung Cancer, 2021, 152: 86-93.
18.	Port JL, Mirza FM, Lee PC, et al. Lobectomy in octogenarians with non-small cell lung cancer: Ramifications of increasing life expectancy and the benefits of minimally invasive surgery. Ann Thorac Surg, 2011, 92(6): 1951-1957.
19.	Tutic-Horn M, Gambazzi F, Rocco G, et al. Curative resection for lung cancer in octogenarians is justified. J Thorac Dis, 2017, 9(2): 296-302.
20.	Saftic I, Bille A, Asemota N, et al. Risks and rewards of the surgical treatment of lung cancer in octogenarians. Interact Cardiovasc Thorac Surg, 2021, 33(6): 905-912.
21.	Cattaneo SM, Park BJ, Wilton AS, et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg, 2008, 85(1): 231-235.
22.	Okami J. Treatment strategy and decision-making for elderly surgical candidates with early lung cancer. J Thorac Dis, 2019, 11(Suppl 7): S987-S997.
23.	Pagès PB, Mariet AS, Madelaine L, et al. Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians. J Thorac Cardiovasc Surg, 2019, 157(4): 1660-1667.
24.	Chen C, Kolbe J, Christmas T. Surgical treatment of non-small-cell lung cancer in octogenarians: A single-centre retrospective study. Intern Med J, 2021, 51(4): 596-599.

1. Lindqvist J, Jekunen A, Sihvo E, et al. Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients. Lung Cancer, 2022, 171: 9-17.
2. 苏雷, 支修益, 张毅, 等. 亚厘米肺结节的外科诊疗分析. 中国微创外科杂志, 2017, 17(1): 11-14.Su L, Zhi XY, Zhang Y, et al. Clinical diagnosis and surgical treatment of sub-centimeter solitary pulmonary nodules. Chin J Min Inv Surg, 2017, 17(1): 11-14.
3. Sawada S, Yamashita N, Sugimoto R, et al. Long-term outcomes of patients with ground-glass opacities detected using CT scanning. Chest, 2017, 151(2): 308-315.
4. 苏雷, 张毅, 李元博, 等. 20~30 mm磨玻璃肺结节的影像学特征及术后病理分析. 医学研究杂志, 2020, 49(11): 54-59.Su L, Zhang Y, Li YB, et al. Analysis of the imaging characteristics and postoperative pathology of 20 to 30 mm ground glass opacity lung nodules. J Med Res, 2020, 49(11): 54-59.
5. Su L, Li Y, Wang T, et al. Synchronous multiple primary lung cancers with shared EGFR mutation but differential imaging findings and pathological subtypes: A case report. Respir Med Case Rep, 2020, 31: 101244.
6. Bak SH, Lee HY, Kim JH, et al. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest, 2016, 149(1): 180-191.
7. Kakinuma R, Noguchi M, Ashizawa K, et al. Natural history of pulmonary subsolid nodules: A prospective multicenter study. J Thorac Oncol, 2016, 11(7): 1012-1028.
8. Pilleron S, Soto-Perez-de-Celis E, Vignat J, et al. Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int J Cancer, 2021, 148(3): 601-608.
9. Li Y, Hu S, Xie J, et al. Effects of surgery on survival of elderly patients with stageⅠ small-cell lung cancer: Analysis of the SEER database. J Cancer Res Clin Oncol, 2019, 145(9): 2397-2404.
10. 苏雷, 张毅, 高艳, 等. 单孔胸腔镜治疗281例老年肺磨玻璃结节患者分析. 医学研究杂志, 2021, 50(9): 27-31, 37.Su L, Zhang Y, Gao Y, et al. Analysis of 281 elderly patients with pulmonary ground-glass opacity treatment by single-port thoracoscopy. J Med Res, 2021, 50(9): 27-31, 37.
11. Blanco R, Maestu I, de la Torre MG, et al. A review of the management of elderly patients with non-small-cell lung cancer. Ann Oncol, 2015, 26(3): 451-463.
12. Suzuki S, Sakurai H, Yotsukura M, et al. Clinical features of ground glass opacity-dominant lung cancer exceeding 3. 0 cm in the whole tumor size. Ann Thorac Surg, 2018, 105(5): 1499-1506.
13. Huang C, Wang C, Wang Y, et al. The prognostic significance of pure ground glass opacities in lung cancer computed tomographic images. J Cancer, 2019, 10(27): 6888-6895.
14. Honda Y, Oka S, Chikaishi Y, et al. Mediastinal lymph node metastases in lung cancer presenting as pure ground-glass nodules: A surgical case report. Int J Surg Case Rep, 2020, 70: 5-7.
15. Zaatar M, Stork T, Valdivia D, et al. Minimal-invasive approach reduces cardiopulmonary complications in elderly after lung cancer surgery. J Thorac Dis, 2020, 12(5): 2372-2379.
16. Kuhn E, Morbini P, Cancellieri A, et al. Adenocarcinoma classification: Patterns and prognosis. Pathologica, 2018, 110(1): 5-11.
17. Thomas PA, Couderc AL, Boulate D, et al. Early-stage non-small cell lung cancer beyond life expectancy: Still not too old for surgery? Lung Cancer, 2021, 152: 86-93.
18. Port JL, Mirza FM, Lee PC, et al. Lobectomy in octogenarians with non-small cell lung cancer: Ramifications of increasing life expectancy and the benefits of minimally invasive surgery. Ann Thorac Surg, 2011, 92(6): 1951-1957.
19. Tutic-Horn M, Gambazzi F, Rocco G, et al. Curative resection for lung cancer in octogenarians is justified. J Thorac Dis, 2017, 9(2): 296-302.
20. Saftic I, Bille A, Asemota N, et al. Risks and rewards of the surgical treatment of lung cancer in octogenarians. Interact Cardiovasc Thorac Surg, 2021, 33(6): 905-912.
21. Cattaneo SM, Park BJ, Wilton AS, et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg, 2008, 85(1): 231-235.
22. Okami J. Treatment strategy and decision-making for elderly surgical candidates with early lung cancer. J Thorac Dis, 2019, 11(Suppl 7): S987-S997.
23. Pagès PB, Mariet AS, Madelaine L, et al. Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians. J Thorac Cardiovasc Surg, 2019, 157(4): 1660-1667.
24. Chen C, Kolbe J, Christmas T. Surgical treatment of non-small-cell lung cancer in octogenarians: A single-centre retrospective study. Intern Med J, 2021, 51(4): 596-599.

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