{
  "abstract": "Objective\n\nTo assess whether high-grade components occupying < 20% of the tumor have prognostic value and whether an Adjusted Grade nomogram improves risk stratification in Stage I invasive lung adenocarcinoma (LUAD).Methods\n\nWe retrospectively analyzed 1539 patients with pathologically confirmed Stage I invasive LUAD undergoing R0 resection; 1321 with follow-up, including 967 with preoperative CT. Tumors were classified by IASLC Grade and reclassified according to predominant pattern and high-grade components; Adjusted Grade 3 was subdivided into MHGC ≤ 5%, DHGC > 5% to < 20%, and SHGC ≥ 20%. Cox models identified DFS predictors. Nomograms were internally validated with 1000 bootstrap resamples and assessed for discrimination, calibration, and net benefit.Results\n\nDuring a median 38-month follow-up, 124 DFS events occurred. Adjusted Grade 3 independently predicted recurrence (HR 3.07, 95% CI 1.54-6.12), while MHGC and DHGC were associated with poorer DFS (HR 3.95, 95% CI 1.53-10.15; HR 2.55, 95% CI 1.12-5.80). In the CT subgroup, consolidation-to-tumor ratio (CTR) independently predicted DFS (HR 3.08, 95% CI 1.46-6.51). Optimism-corrected C-index was 0.740 for the Adjusted Grade-based nomogram, compared with 0.727 for the IASLC-based nomogram and 0.612 for TNM staging. After adding CTR, they were 0.763 and 0.745 for the Adjusted Grade- and IASLC-based nomogram. Decision-curve analysis showed similar net benefit profiles for the two nomograms.Conclusion\n\nHigh-grade components below 20% were associated with poorer DFS. The Adjusted Grade-based nomogram improved internal discrimination versus IASLC Grade and TNM staging but showed no clear clinical-benefit advantage over IASLC Grade. External validation is needed to establish optimal thresholds and clinical utility.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Shuhao Liang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xuanpeng Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Tao Jiang"
    },
    {
      "affs": [
        0
      ],
      "name": "Ming Ni"
    },
    {
      "affs": [
        0
      ],
      "name": "Fei Xue"
    },
    {
      "affs": [
        0
      ],
      "name": "Chenxi Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Tianhao Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Leyu Hong"
    },
    {
      "affs": [
        0
      ],
      "name": "Chao Luo"
    },
    {
      "affs": [
        0
      ],
      "name": "Qifei Wu",
      "orcid": "0000-0002-7439-2831"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2qnnsbs6ay8n6.bib",
  "cited_by": 0,
  "doi": "10.1002/cam4.72439",
  "fulltext_url": "https://europepmc.org/articles/PMC13725225",
  "id": "2qnnsbs6ay8n6",
  "issns": [
    "2045-7634"
  ],
  "landing_url": "https://europepmc.org/article/MED/42968602",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research Article"
    ],
    [
      "openalex",
      "2740|Lung Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7225121570",
  "pdf_url": "https://europepmc.org/articles/PMC13725225?pdf=render",
  "pmcid": "PMC13725225",
  "pmid": "42968602",
  "published": "2026-11-01",
  "publisher": "Wiley",
  "ris": "https://research.draconitic.com/paper/2qnnsbs6ay8n6.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:53Z",
      "native_id": "MED:42968602",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42968602"
    },
    {
      "first_seen": "2026-11-04T12:23:39Z",
      "native_id": "PMC13725225",
      "source": "pmc",
      "url": "https://doi.org/10.1002/cam4.72439"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Lung Cancer Diagnosis and Treatment",
      "subfield": "general"
    }
  ],
  "title": "Association of High-Grade Components < 20% on DFS in Stage I Lung Adenocarcinoma: A Real-World Study of Risk Analysis and Predictive Nomogram Development.",
  "title_text": "Association of High-Grade Components < 20% on DFS in Stage I Lung Adenocarcinoma: A Real-World Study of Risk Analysis and Predictive Nomogram Development.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:21:32Z",
  "url": "https://research.draconitic.com/paper/2qnnsbs6ay8n6",
  "venue": "Cancer medicine",
  "versions": []
}