Prognostic value of ground-glass opacity on computed tomography for patients with pathological stage IA3 lung adenocarcinoma: a multicenter retrospective cohort study

Background: Ground-glass opacity (GGO) on computed tomography (CT) has been suggested as a potential prognostic factor in lung adenocarcinoma (LUAD), but its significance in patients with pathological stage IA3 LUAD, particularly in relation to micropapillary (MIP) status, remains unclear. This study addresses the clinical need to stratify patients based on GGO and MIP status to optimize prognosis prediction and follow-up strategies. Methods: A multicenter retrospective study was conducted on 411 patients with pathological stage IA3 LUAD, enrolled between July 2012 and July 2020. Patients were divided into two groups based on the presence of GGO. The association of GGO with recurrence-free survival (RFS) and cancer-specific survival (CSS) of patients with different MIP status was assessed, stratified by MIP status (MIP ≥5% was classified as positive, and MIP <5% as negative). A life-table analysis was used to calculate dynamic recurrence curves of subgroups formed by GGO and MIP and to establish a personalized follow-up strategy. Results: The analysis indicated that GGO was associated with prolonged RFS (P<0.001) and CSS (P=0.006) in MIP-negative patients but not for MIP-positive patients. Time-dependent Cox multivariate analysis further showed that GGO was a favorable prognostic factor for RFS (P=0.03) and CSS (P=0.04) even at 2 years postoperatively. Based on GGO components and MIP status, patients were categorized into the four following subgroups: MIP(+)-GGO(+), MIP(+)-GGO(−), MIP(−)-GGO(+), and MIP(−)-GGO(−); the recommended number of follow-up visits for these four subgroups within 5 years were 3, 9, 3, and 11, respectively. Conclusions: The GGO component demonstrated a beneficial prognostic effect primarily in MIP-negative patients with pathological stage IA3 LUAD, sustained for up to 2 years. The variation in recurrence risk across subgroups underscores the importance of personalized follow-up strategies based on GGO and MIP status to optimize patient monitoring and care.