| Objective:Non-small cell lung cancer(NSCLC)is one of the most common malignant tumors in China.Early diagnosis is of great significance to the treatment and prognosis of NSCLC patients.circulating tumor cell(CTC)detection,an important component of liquid biopsy,is of great value in prognosis assessment and therapeutic intervention of patients with NSCLC.In 2010,CTC analysis was written into the American Joint Committee on Cancer(AJCC)Cancer Staging Manual as a new marker to complement pathological staging,appearing between M0 and M1 as cM0(i+).The aim of this study is to analyze the correlation between FR+CTC(folate receptor-positive circulating tumor cells)of the benign and malignant lesions of the lung,and to establish a malignant prediction model for pulmonary neoplasm based on clinical data,imaging and FR+CTC tests.Methods:A retrospective analysis has been done on the data of 1277 cases admitted by the affiliated Hospital of Qingdao University from September 2018 to December 2019.The patients,including 518 male patients and 759 female patients,with a median age of 57(29-85),underwent CTC examination of peripheral blood and had pathological results of pulmonary nodules and lung tumors.The patients were randomly divided into the experimental group and the validation group,univariate and multivariate analyses have been realized on the data of the two groups.Then the Nomogram prediction model was established and verified internally and externally.ROC(receiver operating characteristic)curve was used to test the differentiation of the model and calibration curve was used to test the consistency of the model.Results:1277 patients were randomly divided into the experimental group(925Ⅲ patients with NSCLC and 113 patients with benign diseases)and the verification group(219 patients with NSCLC and 20 patients with benign diseases).In the experimental group,the mean age of patients was 59.15 years,including 60 years for NSCLC patients and 57 years for benign nodules.In the validation group,the mean age of patients was 59.29 years,including 59.71 years for NSCLC patients and 54.35 years for benign nodules.The FR+CTC in peripheral blood of NSCLC patients is significantly higher than the one found in the lungs of the patients who are in favorite conditions.(11.5 vs 7.6 P<0.001).Multivariate analysis showed that ’age≥60 years old(OR 1.700;95%CI 1.002-2.884;P=0.049),female(OR 2.617;95%CI 1.541-4.442;P<0.001),FR+CTC value>8.7(OR 16.992;95%CI 9.728-29.682;P<0.001),positive pleural traction sign(OR 2.199;95%CI 1.195-4.405;P=0.011),nodule diameter(OR 1.728;95%CI 1.244-2.402;P=0.001),positive burr sign(OR 6.322;95%CI 3.561-11.225;P<0.001),CTR(consolidation/tumor ratio)<1(OR 3.172;95%CI 2.264-4.446;P<0.001)’ were factors make difference between the diameter of the benign and malignant lesions is less or equals to 4cm.Thereby,the Nomogram prediction model was established.The AUC(area under the curve)value under the ROC curve of the experimental group was 0.918(95%CI 0.900～0.934),the sensitivity was 86.36%,and the specificity was 83.19%.The AUC value of the verification group was 0.903(95%CI 0.859～0.938).When the cut-off point T=0.6955,the Youden index is the largest the sensitivity of the model is 79,45%,and the specificity was 90.00%,indicating Nomogram model discrimination is efficient.The calibration curve also shows that the Nomogram model calibration works well.Conclusion:FR+CTC in peripheral blood of NSCLC patients was significantly higher than the one found in the lungs of the patients who carry benign pulmonary diseases.The ’age≥60 years old,female,FR+CTC value>8.7,positive pleural traction sign,nodule diameter,positive burr sign,CTR<1’ were factors make difference between the diameter of the benign and malignant lesions is less or equals to 4cm.The diagnostic model of clinical stage I NSCLC established in this study is with a good accuracy and can provide a basis for clinical diagnosis and guide the follow-up minimally invasive surgical treatment. |
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