Objectives Our study aims to compare the clinicopathological, genetic, and prognostic differences between pure-solid appearance clinical stage I mucinous and non-mucinous adenocarcinomas. Materials and methods Five hundred seventy-nine patients with radiological pure-solid appearance clinical stage I lung adenocarcinoma, were retrospectively evaluated. Clinicopathological, radiological, genetic characteristics, and recurrence patterns were compared between the non-mucinous adenocarcinoma and mucinous adenocarcinoma groups. Recurrence-free survival (RFS) and overall survival (OS) were assessed by Kaplan–Meier curves and compared between groups using log-rank tests. Cox proportional hazard models were used to analyze prognostic factors. Results Of 579 patients (mean age, 59.9 years ± 9.7 [SD]; 298 women), 442 had non-mucinous adenocarcinoma, and 137 had mucinous adenocarcinoma. The non-mucinous adenocarcinoma group, in comparison with mucinous adenocarcinoma, showed higher CEA levels (p = 0.003), higher CT values (36.88 vs 20.89 HU, p < 0.001), a higher incidence of emphysema (25.1% vs 3.6%, p < 0.001), a lower clinical T stage (51.8% vs 42.3%, p < 0.001), and the absence of air bronchogram (61.3% vs 27%, p < 0.001). Recurrences occurred more frequently in the non-mucinous adenocarcinoma group (38.5%, 170/442) compared to the mucinous adenocarcinoma group (13.1%, 18/137; p < 0.001). Brain metastasis was significantly more common in the non-mucinous adenocarcinoma group (27.1% vs 0%; p = 0.024). Compared with the non-mucinous adenocarcinoma group, the mucinous adenocarcinoma group had better 5-year RFS (86.9% vs 62.7%; p < 0.001) and 5-year OS (97.1% vs 83.2%, p < 0.001). Conclusion Imaging features, survival outcomes, and recurrence patterns differed significantly between mucinous and non-mucinous lung adenocarcinomas. Key Points <UnorderedList Mark="Bullet"> <ItemContent> <Emphasis Type="BoldItalic">Question</Emphasis> For radiological pure-solid appearance clinical stage I lung adenocarcinoma, there remains controversy regarding the clinicopathological characteristics and prognosis of mucinous versus non-mucinous subtypes. </ItemContent> <ItemContent> <Emphasis Type="BoldItalic">Findings</Emphasis> There were significant differences in clinicopathological features, imaging findings, and recurrence patterns between mucinous and non-mucinous adenocarcinomas. Compared with the non-mucinous adenocarcinoma, the mucinous group had better 5-year RFS and 5-year OS. </ItemContent> <ItemContent> <Emphasis Type="BoldItalic">Critical relevance statement</Emphasis> Lung mucinous adenocarcinoma, Lung mucinous adenocarcinoma, due to its unique imaging and clinicopathological features, was a special independent subtype of adenocarcinoma. For radiological pure-solid appearance lung adenocarcinoma, mucinous adenocarcinoma had a better survival prognosis than non-mucinous adenocarcinoma. </ItemContent> </UnorderedList> Graphical Abstract

Radiological pure-solid appearance clinical stage I lung adenocarcinoma: a comparative study of mucinous and non-mucinous adenocarcinoma based on imaging features and survival outcomes

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2026年7月23日

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Wei Li,
He Du,
Shixing Wu,
Jingyi Wang,
Nan Song,
Ziwei Wan,
Fengying Wu,
Jingyun Shi

摘要

Objectives

Our study aims to compare the clinicopathological, genetic, and prognostic differences between pure-solid appearance clinical stage I mucinous and non-mucinous adenocarcinomas.

Materials and methods

Five hundred seventy-nine patients with radiological pure-solid appearance clinical stage I lung adenocarcinoma, were retrospectively evaluated. Clinicopathological, radiological, genetic characteristics, and recurrence patterns were compared between the non-mucinous adenocarcinoma and mucinous adenocarcinoma groups. Recurrence-free survival (RFS) and overall survival (OS) were assessed by Kaplan–Meier curves and compared between groups using log-rank tests. Cox proportional hazard models were used to analyze prognostic factors.

Results

Of 579 patients (mean age, 59.9 years ± 9.7 [SD]; 298 women), 442 had non-mucinous adenocarcinoma, and 137 had mucinous adenocarcinoma. The non-mucinous adenocarcinoma group, in comparison with mucinous adenocarcinoma, showed higher CEA levels (p = 0.003), higher CT values (36.88 vs 20.89 HU, p < 0.001), a higher incidence of emphysema (25.1% vs 3.6%, p < 0.001), a lower clinical T stage (51.8% vs 42.3%, p < 0.001), and the absence of air bronchogram (61.3% vs 27%, p < 0.001). Recurrences occurred more frequently in the non-mucinous adenocarcinoma group (38.5%, 170/442) compared to the mucinous adenocarcinoma group (13.1%, 18/137; p < 0.001). Brain metastasis was significantly more common in the non-mucinous adenocarcinoma group (27.1% vs 0%; p = 0.024). Compared with the non-mucinous adenocarcinoma group, the mucinous adenocarcinoma group had better 5-year RFS (86.9% vs 62.7%; p < 0.001) and 5-year OS (97.1% vs 83.2%, p < 0.001).

Conclusion

Imaging features, survival outcomes, and recurrence patterns differed significantly between mucinous and non-mucinous lung adenocarcinomas.

Key Points

Question For radiological pure-solid appearance clinical stage I lung adenocarcinoma, there remains controversy regarding the clinicopathological characteristics and prognosis of mucinous versus non-mucinous subtypes.

Findings There were significant differences in clinicopathological features, imaging findings, and recurrence patterns between mucinous and non-mucinous adenocarcinomas. Compared with the non-mucinous adenocarcinoma, the mucinous group had better 5-year RFS and 5-year OS.

Critical relevance statement Lung mucinous adenocarcinoma, Lung mucinous adenocarcinoma, due to its unique imaging and clinicopathological features, was a special independent subtype of adenocarcinoma. For radiological pure-solid appearance lung adenocarcinoma, mucinous adenocarcinoma had a better survival prognosis than non-mucinous adenocarcinoma.

Graphical Abstract