Prognostic Variability in Non-Small Cell Lung Cancer with Pathologic Separate Nodules in the Same Lobe at CT.

Background Patients with stage T3 non-small cell lung cancer (NSCLC) with separate nodules (SNs) have been reported to have better outcomes than those with T3 tumors with other descriptors, but heterogeneity may exist depending on nodule characteristics. Purpose To identify prognostic factors based on the imaging features of SNs among patients with pathologically confirmed SNs in the same lobe. Materials and Methods This retrospective study included patients with pT2b-pT3 NSCLC who underwent lobectomy or pneumonectomy between January 2010 and December 2021. Radiologic features of the SNs were evaluated. Recurrence-free survival (RFS) and overall survival (OS) were evaluated with Cox proportional hazards regression. Results A total of 1107 patients were evaluated (mean age, 64.8 years ± 9.8 [SD]; 766 male; 498 with pT2b; 141 with SNs; 468 with pT3-other descriptors). In patients with SNs, subsolid SNs were an independent negative prognostic factor for both RFS (hazard ratio [HR], 0.26 [95% CI: 0.12, 0.57]; P = .001) and OS (HR, 0.11 [95% CI: 0.04, 0.32]; P < .001). The number of SNs was an independent positive prognostic factor for RFS (HR, 2.40 [95% CI: 1.24, 4.64]; P = .009). In patients with solid SNs, a nonregional location was the only prognostic factor for shorter OS (HR, 1.92 [95% CI: 1.04, 3.56]; P = .04). No difference was identified between patients with subsolid SNs and those with pT2b tumors for RFS or OS (P > .99). Patients with subsolid SNs had better survival than those with solid SNs (P < .001 for RFS and OS) or pT3-other descriptor tumors (P = .002 for RFS; P < .001 for OS). No survival difference was detected between patients with solid SNs and those with pT3-other descriptor tumors (P > .99). Conclusion In patients with surgically resected NSCLC and pathologic SNs in the same lobe, the presence of ground-glass opacity was associated with outcome. Only subsolid SNs were associated with higher survival rates compared with pT3-other descriptor tumors. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Goo in this issue.