Abstract 4519: Lung carcinoma with air lucency: Possible classification and their prognosis

Background: Lung cancer with air lucency (LCAL) represents a group of lesions in which a primary lung cancer manifests on CT images with a cyst or cystic airspaces. NSCLCs with adjoining cystic airspaces have been reported an increased risk of poor prognosis after surgical resection. However, the detailed classification of LCALs based on diagnostic imaging have not yet been established. We aim to classify LCALs into emphysematous and non-emphysematous groups objectively, and then analyze the prognosis of each group. Methods: A total of 101 surgically resected LCAL cases in our institution between 2015 and 2022 (including all cancer stages and histological subtypes) were collected. Cases were separated into emphysematous and non-emphysematous groups based on Goddard’s score, derived from LAA% (Low Attenuation Area percentages) analyzed in CT scans. A Goddard’s score of 1 or more was considered emphysematous in this study. Then, clinicopathological features and prognosis for each group were analyzed. Result: Sixty (59%) cases were classified as emphysematous, and forty-one (41%) cases as non-emphysematous. Higher pathological stages (worse than IIB) were more common in the emphysematous group (p-value<0.01). For respiratory performance (FEV1%), the emphysematous group had worse outcomes compared to the non-emphysematous group (p-value=0.01). Kaplan-Meier analysis revealed that the emphysematous group had a significantly worse overall survival (p-value=0.02). In multivariate analysis, a Goddard score of 1 or more, advanced TNM staging, and tumor histology subtypes other than adenocarcinoma were identified as independent risk factors for poor prognosis in LCAL patients. Conclusion: LCALs can be categorized using Goddard’s score into emphysematous and non-emphysematous groups, with the emphysematous group showing poorer overall survival. This result suggests that patients with emphysematous LCALs should be considered at high risk for poor outcomes following surgery. This classification may help identify patients who require alternative therapeutic strategies and/or more cautious post-operative management. Citation Format: Kazuya Hisamatsu, Kazuhiko Shien, Shuta Tomida, Daisuke Mizuno, Ryota Fujiwara, Kousei Ishimura, Ryunosuke Fujii, Atsushi Matsuoka, Ryo Yoshichika, Tomoaki Higashihara, Naohiro Hayashi, Yuma Fukumoto, Kazuhiro Okada, Fumiaki Mukohara, Mao Yoshikawa, Ken Suzawa, Shinichi Toyooka. Lung carcinoma with air lucency: Possible classification and their prognosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4519.