早期肺腺癌患者术前胸部CT扫描的地玻璃状混浊灶的预后价值尚存在争议。我们旨在通过一项单中心回顾性队列研究，阐明现有证据，并通过进行荟萃分析对文献进行定量总结。在回顾性队列研究中，我们确定了临床Ⅰ期肺腺癌患者，并使用多变量Cox回归分析地玻璃状混浊灶的预后价值。商业化的人工智能软件被作为第二读者用于判断地玻璃状混浊灶的存在。主要终点是无复发生存（FFR）和肺癌特异性生存（LCSS）。在一项荟萃分析中，我们系统地搜索了Embase和OVID-MEDLINE，截止到2021年12月30日，寻找以第八版分期系统为基础的研究。通过多水平随机效应模型计算实质性结节（即无地玻璃状混浊灶）与不同终点之间的合并风险比（HR）。 在一个由612名患者组成的队列研究中，实质性结节与FFR（调整HR为1.98，95% CI：1.17-3.51，p = 0.01）和LCSS（调整HR为1.937，95% CI：1.002-4.065，p = 0.049）的预后较差相关。人工智能评估和多种敏感性分析结果一致。荟萃分析包括13项研究，涉及12080名患者。实质性结节的合并HR为2.13（95% CI：1.69-2.67，I2 = 30.4%），其对于总生存期的合并HR为2.45（95% CI：1.52-3.95，I2 = 0.0%），对于无复发生存的合并HR为2.50（95% CI：1.28-4.91，I2 = 30.6%）。 早期肺腺癌中的实质性结节与较差的术后生存相关。表现为实质性结节的早期肺腺癌在术前胸部CT中显示缺乏地玻璃状混浊灶，其与术后较差的生存相关。在下一版分期系统中，临床T分期的改进有待进一步探讨。 • 在一个包括612名Ⅰ期肺腺癌患者的回顾性研究中，实质性结节与较短的无复发生存（调整风险比[HR] = 1.98，p = 0.01）和肺癌特异性生存（调整HR = 1.937，p = 0.049）相关。 • 人工智能评估的实质性结节也显示出较差的预后（无复发生存的调整HR为1.94 [p = 0.01]；肺癌特异性生存的调整HR为1.93 [p = 0.04]）。 • 在荟萃分析中，实质性结节与较短的无复发生存（HR = 2.45）和较短的总生存期（HR = 2.13）相关。 © 2023. 作者经欧洲放射学学会独家许可。

The prognostic value of ground-glass opacity at preoperative chest CT scans in early-stage lung adenocarcinomas is a matter of debate. We aimed to clarify the existing evidence through a single-center, retrospective cohort study and to quantitatively summarize the body of literature by conducting a meta-analysis.In a retrospective cohort study, patients with clinical stage I lung adenocarcinoma were identified, and the prognostic value of ground-glass opacity was analyzed using multivariable Cox regression. Commercial artificial intelligence software was adopted as the second reader for the presence of ground-glass opacity. The primary end points were freedom from recurrence (FFR) and lung cancer-specific survival (LCSS). In a meta-analysis, we systematically searched Embase and OVID-MEDLINE up to December 30, 2021, for the studies based on the eighth-edition staging system. The pooled hazard ratios (HRs) of solid nodules (i.e., absence of ground-glass opacity) for various end points were calculated with a multi-level random effects model.In a cohort of 612 patients, solid nodules were associated with worse outcomes for FFR (adjusted HR, 1.98; 95% CI: 1.17-3.51; p = 0.01) and LCSS (adjusted HR, 1.937; 95% CI: 1.002-4.065; p = 0.049). The artificial intelligence assessment and multiple sensitivity analyses revealed consistent results. The meta-analysis included 13 studies with 12,080 patients. The pooled HR of solid nodules was 2.13 (95% CI: 1.69-2.67; I2 = 30.4%) for overall survival, 2.45 (95% CI: 1.52-3.95; I2 = 0.0%) for FFR, and 2.50 (95% CI: 1.28-4.91; I2 = 30.6%) for recurrence-free survival.The absence of ground-glass opacity in early-stage lung adenocarcinomas is associated with worse postoperative survival.Early-stage lung adenocarcinomas manifesting as solid nodules at preoperative chest CT, which indicates the absence of ground-glass opacity, were associated with poor postoperative survival. There is room for improvement of the clinical T categorization in the next edition staging system.• In a retrospective study of 612 patients with stage I lung adenocarcinoma, solid nodules were associated with shorter freedom from recurrence (adjusted hazard ratio [HR], 1.98; p = 0.01) and lung cancer-specific survival (adjusted HR, 1.937; p = 0.049). • Artificial intelligence-assessed solid nodules also showed worse prognosis (adjusted HR for freedom from recurrence, 1.94 [p = 0.01]; adjusted HR for lung cancer-specific survival, 1.93 [p = 0.04]). • In meta-analyses, the solid nodules were associated with shorter freedom from recurrence (HR, 2.45) and shorter overall survival (HR, 2.13).© 2023. The Author(s), under exclusive licence to European Society of Radiology.