Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces

A Correction to this article was published on 08 July 2020

This article has been updated



Subsolid lung adenocarcinoma with cystic airspaces (LACA) is a unique manifestation of lung cancer. This study was conducted to establish a radiologic disease progression model of LACA and to explore its association with the clinical course and clinicopathologic features of LACA.

Materials and Methods

Sixty patients with LACA who underwent surgery at our center between 2004 and 2017 were retrospectively reviewed. The morphological changes of LACA over time on 98 serial computed tomography scans from 27 of 60 patients were tracked to establish a radiologic disease progression model. Associations between this model and the clinicopathologic characteristics of LACA were investigated.


The following stepwise progression model of LACA was developed: in phase I, cystic airspaces (CAs) appear in the middle of non-solid nodules; in phase II, the CAs grow; in phase III, a solid component appears on the border of the CAs; and in phase IV, the solid component gradually surrounds the CAs and becomes thicker, and the CAs shrink. In total, 10 (17%), 33 (55%), and 17 (28%) LACA patients were classified as belonging to phases II, III, and IV at the time of surgery, respectively. More advanced phases were associated with higher pathologic T and N staging, lymphovascular invasion, visceral pleural invasion, spread through air spaces, and solid/micropapillary subtype. In the multivariate analysis, our model demonstrated a good discrimination capability for cancer recurrence risk.


The stepwise disease progression model of LACA based on radiologic findings developed in this study represented its natural clinical course and clinicopathologic features well.

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Change history

  • 08 July 2020

    In the original article there are errors in Fig.��3. Following is the corrected figure.


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The authors thank the Division of Statistics in the Medical Research Collaborating Center at SNUBH for assistance with the statistical analyses.


This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Corresponding author

Correspondence to Sukki Cho MD, PhD.

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Woohyun Jung, Sukki Cho, Sungwon Yum, Jin-Haeng Chung, Kyung won Lee, Kwhanmien Kim, Choon Taek Lee, and Sanghoon Jheon have no conflicts of interest to declare.

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Electronic Supplementary Material

Flow chart summarizing the study methods: (1) search strategy for patients with lung adenocarcinoma with cystic airspaces (LACA) using our prospective collected database system, clinical data warehouse (CDW), and electronic medical records (EMR); (2) construction of the disease progression model; and (3) model verification.

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Jung, W., Cho, S., Yum, S. et al. Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces. Ann Surg Oncol 27, 4394–4403 (2020).

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