A Clinical Study On Predicting The Risk Factors Of Invasive Adenocarcinoma In Solitary Pure Lung Ground Glass Nodules

Objective:Pulmonary ground-glass nodules may be the early stages of lung adenocarcinoma,but sometimes are invasive adenocarcinomas.The purpose of this study is to retrospectively analyze the clinical features,imaging features,pathological classification and so on of patients with isolated pure pulmonary ground-glass nodules treated by surgery in the Affiliated Hospital of Yangzhou University to predict the risk factors of invasive adenocarcinomas.Methods:A retrospective study was performed on patients with isolated pure pulmonary ground-glass nodules treated surgically between January 2016 and August 2017 at the Affiliated Hospital of Yangzhou University,with clear pathological results.Ultimately,60 patients were enrolled in this study.The patients were divided into invasive adenocarcinoma group and non-invasive adenocarcinoma group(preinvasion lesion and minimally invasive adenocarcinoma)according to pathological classification and detailed recorded of the patient's generalclinical data,imaging features,pathological types.48(80%)cases patients were non-invasiveadenocarcinoma,12(20%)cases of patients with invasive adenocarcinoma.Compare differences in the two groups of the clinical features(sex,age,smoking history,history of lung cancer,CEA,pulmonary function)and imaging features(nodule diameter,CT value,nodule location,lobulation sign,pleural retraction,bubble-like lucency,access of vascularinto lesion,air bronchogram sign)and the ratio of EGFR mutation.The normal quantitative data were analyzed by two independent samples t test.The count data were analyzed by x2 test.The significant variables in the univariate analysis were included in the multivariate regression analysis.Dichotomous logistic regression to determine the independentrisk factors for invasive adenocarcinoma.Finally,in the ROC curve,with predictive risk factors as the predictor,invasive adenocarcinoma was predicted.Results:The results of univariate analysis showed that CEA,nodule diameter,CT value and pleural retraction were statistically significant(t =-2.287,P = 0.026;t =-9.618,P<0.001;t =-2.086,P = 0.041;x2 = 7.656,P = 0.006).Non-invasive adenocarcinoma group CEA value,nodular diameter size,CT value,pleural retraction level were lower than invasive adenocarcinoma group.There was no significant difference between the two groups in sex,age,smoking history,history of lung cancer,lung function,nodule location,lobulation sign,bubble-like lucency,access of vascular into lesion,air bronchogram sign and EGFR mutation ratio.Univariate logistic regression was used to investigate the significance of univariate analysis(CEA,nodule diameter,CT value,pleural retraction)in the multivariate regression analysis.The results showed that the diameter of the nodule(OR = 3.501)and pleural retraction(OR = 10.644)were independent risk factors for invasive adenocarcinoma.,CT value and CEA are not independent risk factors for invasive adenocarcinoma.The receiver operating characteristic curve was used to predict the invasive adenocarcinoma based on the nodule diameter.The results showed that the area under the curve was 0.889,the sensitivity was 91.67%,the specificity was 81.25%,and the Youden index was 0.729.The results showed that with nodules Diameter of 13.17mm for the cut-off value of invasive adenocarcinoma has a good predictive effect.Conclusions:The diameters of isolated pure pulmonary ground-glass nodules and computed tomography findings of pleura retraction are independent risk factors for invasive adenocarcinoma.When the diameter of isolated pure pulmonary ground-glass nodules is larger than 13.17 mm,there is a good correlation with invasive adenocarcinoma.If considered as invasive adenocarcinoma,recommended lobectomy.