A New Method For Predicting Postoperative Recurrence And Metastasis Of Patients With Stage ⅠA Lung Adenocarcinoma

Background and objective: The widespread application of low-dose CT has increased the detection rate of stage ⅠA lung cancer.Despite the early stage,some patients still have recurrence and metastasis after surgery.The TNM staging system is the cornerstone of judging the prognosis of patients.However,the prognosis of patients in the same stage and the same operation method is still different.This means that there may be other factors affecting its prognosis.This study aims to explore the risk factors of recurrence and metastasis in patients with stage ⅠA lung adenocarcinoma after thoracoscopic lobectomy,and construct a nomogram based on these risk factors to predict the risk of recurrence and metastasis,so as to formulate individualized treatment strategies and follow-up time.Methods: Analyze the data of patients with lung adenocarcinoma stage ⅠA in Fujian Union Hospital who underwent thoracoscopic lobectomy.Based on previous reports,select gender,age,smoking history,tumor diameter,classification of adenocarcinoma,pathological subtype,preoperative tumor markers(including CEA,CA125 and CYFRA21-1),vascular tumor thrombus,preoperative imaging features,whether there are clinical symptoms at the first diagnosis,whether there is a previous medical history(hypertension,diabetes),tumor growth location and other pathological and clinical indicators are analyzed.Use SPSS.25 and R4.0.4 for data processing,use logistic single factor,multivariate analysis and COX regression equation to determine the independent risk factors that affect postoperative recurrence and metastasis in patients with stage ⅠA lung adenocarcinoma,and calculate the Hosmer-Lemeshow fit(H)Evaluate the goodness of fit of independent risk factors.Kaplan-Meier was used to fit the survival curve,and the survival rate between groups was compared by Log-Rank method.P<0.05 indicated that the difference was statistically significant.Draw a nomogram chart according to the analysis results of the COX regression equation,use the consistency index(C-index)and the Bootstrap method(self-sampling number B=1000)to verify the nomogram chart,and draw a nomogram standard curve to evaluate its predictive value.The closer the C-index is to 1.0,the higher the predictive value of the model.Inspection level X=0.05.Results: A total of 337 patients with stage ⅠA lung adenocarcinoma were included in this study,and the median follow-up time was 47 months(32-80 months).The results of univariate analysis showed that factors such as gender,age,preoperative imaging characteristics,tumor diameter,tumor pathological subtype,preoperative CEA and CYFRA21-1 levels were related to tumor recurrence and metastasis.We further incorporated these 7 factors into the multivariate regression model,and the results showed that: tumor diameter,pathological subtype,preoperative CEA and CYFRA21-1levels,etc.,are independent of postoperative recurrence and metastasis in patients with stage ⅠA lung adenocarcinoma.Risk factors(P<0.05),Hosmer-Lemeshow fit(H)P=0.818 indicates a good fit.Based on these risk factors,a nomogram was drawn to predict postoperative recurrence and metastasis in patients with stage ⅠA lung adenocarcinoma.Finally,internal verification was carried out by Bootstrap method,and the consistency index(C-index)was 0.943(95%CI:0.9092-0.9768),indicating that the model has good predictive performance.Conclusions: This study clarified that 4 factors including tumor diameter,pathological subtype,preoperative CEA and CYFRA21-1 levels are independent risk factors for recurrence and metastasis in patients with stage ⅠA lung adenocarcinoma after thoracoscopic lobectomy,and constructed based on the above risk factors The nomogram map is used to predict the risk of recurrence and metastasis,so as to screen high-risk groups,formulate appropriate treatment strategies and follow-up time.In addition,this study showed that the preoperative tumor markers CEA and CYFRA21-1are independent risk factors for postoperative recurrence and metastasis in patients with stage ⅠA lung adenocarcinoma,suggesting that preoperative tumor markers are useful in predicting postoperative recurrence in patients with stage ⅠA lung adenocarcinoma.And metastasis has clinical guiding significance.The author believes that patients with high preoperative tumor markers should pay more attention to complete tumor resection and lymph node dissection.