title: Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions.
abstract: OBJECTIVE
  We reviewed the medical record of a series of patients with synchronous multiple lung cancers (SMLC), in an attempt to identify the optimal treatment strategy for multiple ground-glass opacities (GGOs).
  
  
  METHODS
  From 2004 to 2010, 1223 patients underwent complete resection of non-small cell lung cancer. Among these, there were 67 patients (5.5%) with SMLC with at least 1 of the nodules showing GGO appearance. SMLC was divided into the main cancer (MC) which was a main target based on its tumor size or radiological invasiveness and sub-nodules. According to consolidation/tumor ratio (CTR) on thin-section computed tomography, 67 cases were classified into GG-group (MC showing GGO-dominant lesion; CTR≤0.5) and GS-group (MC showing solid-dominant lesion; CTR>0.5).
  
  
  RESULTS
  There were 24 patients in the GG-group (36%) and 43 patients in the GS-group (64%). Surgical resections included 11 sublobar resections (SLs), 32 lobectomies, 19 lobectomy+SLs, and 4 bilobectomies. There were 39 patients with a total of 118 unresected GGOs after the initial surgery. Among them, the frequency of growth was 8% on a per-nodule basis with the median tumor doubling time of 1373 days, and new GGOs emerged in 15 patients (23%). Multivariate analysis demonstrated that larger size of MC and the GS-group was associated with poor prognosis, whereas growth of the residual GGOs, the development of new GGOs, or whether or not all GGOs were treated did not affect survival. The 5-year OS proportions were 95.8% for the GG-group and 68.0% for the GS-group (p=0.009), and 92.4% for a MC of ≤25 mm and 53.6% for a MC of >25 mm (p=0.008).
  
  
  CONCLUSIONS
  Survival of patients with multifocal GGOs is strongly affected by radiological findings of the MC. Strict surgical control for MC could be most important.
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan. Electronic address: zenkyu@za3.so-net.ne.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Chest Surgery, St. Marianna University School of Medicine, Yokohama, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Saji
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Otani
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Sachio
authors.initials: S
authors.lastname: Maehara
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Maeda
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kato
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Hagiwara
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kakihana
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kajiwara
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ohira
authors.affiliation: Department of Radiology, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Akata
authors.affiliation: First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Ground-glass opacity; Multiple lung cancer; Non-small cell lung cancer; Surgical resection