| Objectives:Ground-glass nodules(GGNs)is an imaging term for early-stage lung adenocarcinoma with a predominantly lepidic growth pattern that often appears as GGNs on CT images.In recent years,immune checkpoint inhibitors therapy(ICIs),also called immunotherapy,has greatly improved the prognosis of patients with advanced lung cancer.However,there is still a lack of clinical evidence on whether immunotherapy is effective in early-stage lung cancer,especially those presenting as GGNs.Methods:Patients with malignancies,who sought medical services in the Second Xiangya Hospital from January 1,2016 to June 31,2021and met the following criteria,were included:(1)received immunotherapy for at least 2 cycles;(2)underwent thin-slice(1 mm)computed tomography images(CT)of the chest before immunotherapy(3)the pre-immunotherapy CT suggested the presence of 4-30 mm GGNs lesions;(4)underwent thin-section CT testing within 1 month after the end of immunotherapy.The last CT image before the immunotherapy(CT1)and the last CT image after the immunotherapy(CT2)were collected to assess the changes in GGNs during immunotherapy.Results:(1)A total of 76 GGNs in 39 patients with malignancies were observed.We found that after immunotherapy,Comparing the changes in nodule size,density,and solid component before and after immunotherapy,the maximum diameter was significantly reduced after immunotherapy(p=0.020),and there was no significant difference in volume,density,and maximum of solid component.However,the maximum of solid proportion was increased after immunotherapy(p<0.05);(2)Lung-RADS classification remained unchanged after immunotherapy in 74.6%(53/71)of Lung-RADS category 2 or 3 GGNs lesions,whereas 80%(4/5)of Lung-RADS category 4 nodules became classified as category 2 or 3 after immunotherapy.(3)The response rate(RR)of immunotherapy on GGNs lesions was evaluated using the Fleischner Society Lung Nodule Guidelines,the American College of Radiology(ACR)Lung Nodule Guidelines,and the British Thoracic Society(BTS)Lung Nodule Guidelines,all of which showed lesion shrinkage.The results of efficacy assessment of immunotherapy for GGNs were different when evaluated using different guidelines;(4)When the efficacy of immunotherapy for GGNs lesions was assessed using RESIST 1.1 criteria,a total of 9 GGNs achieved PR,59 GGNs achieved SD,and 8 GGNs achieved PD,with an ORR of 11.8%(9/76);(5)Fifteen of the 39 patients with tumors achieved CR or PR in the primary lesion,with an ORR of 36.8%,and a total of 34 GGNs(44.7%)were consistent with the efficacy of immunotherapy in the primary lesion.There was no significant difference(p=0.19)and significant correlation(p=0.48)between the efficacy of GGNs lesions and the primary lesion;(6)The univariate results showed that the maximum diameter and volume of GGNs were positively correlated with the efficacy of immunotherapy in GGNs,and the larger the length and volume of GGNs were more likely to benefit from immunotherapy(p<0.05).In contrast,multifactorial analysis showed that GGNs density(p=0.012)and volume(p=0.039)were independent predictors of the efficacy of immunotherapy of GGNs.Conclusion:PD-1/PD-L1 inhibitors show activity on GGNs lesions in patients with malignant tumors,these GGN lesions were significant benefit if they presented with the diameter of GGNs≥8 mm,with the volume≥70 mm~3 or the density of GGNs≥-500 HU. |
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