Preliminary Discussion On T-staging Of Thin-walled Cystic Non-small Cell Lung Cancer

Objective:This study intends to analyze and compare the preoperative systemic immune-inflammation index(SII)and postoperative survival rate in patients with thin-walled cystic non-small cell lung cancer and non-cystic non-small cell lung cancer,and to explore whether the gaseous cystic in thin-walled cystic lung cancer should be adopted as a basis for T staging to guide clinical staging and treatment more accurately.Methods:The clinical and imaging data of patients with non-small cell lung cancer(n=506)who underwent surgery in the affiliated Hospital of Zunyi Medical University from January 2012 to September 2021 were collected and divided into two groups according to the inclusion and exclusion criteria:thin-walled cystic non-small cell lung cancer group(cystic group,n=39)and non-cystic non-small cell lung cancer group(non-cystic group,n=467).First,in order to verify the relationship between systemic immune-inflammation index and T staging,patients in the non-cystic group were divided into three groups:T1,T2 and T3 according to the eighth edition TNM staging,and the systemic immuneinflammation index of the three groups were compared.The patients with different T stage were selected,which measured the maximum diameter of the whole lesion and the residual lesion except the gaseous cystic in the cystic group.According to the lesion size,sex and age,these patients were propensity score matched(PSM)with non-cystic group patients with the same T staging at 1:2.The reasonable T staging of thin-walled cystic lung cancer was preliminarily discussed by comparing and analyzing the difference of preoperative systemic immune-inflammation index and postoperative survival rate.Results:1.The results of systemic immune-inflammation index in non-cystic group were as follows:the SII value of T1 staging was 373.14(272.92,519.46),which was lower than that of T2 staging 558.01(342.92,872.09),and the difference was statistically significant(Z=-4.731,P=0.000).The SII value of T2 staging was 558.01(342.92,872.09),which was lower than that of T3 staging 796.05(620.75,1030.76),and the difference was statistically significant(Z=-2.614,P=0.009).With the increase of T staging,the SII value increased.2.After matching the total 18 patients with measurement of the entire maximum diameter of the wholel lesion of cystic lung cancer in T2 staging and non-cystic lung cancer at the same T2 staging,the SII value in the cystic group was 325.82(194.43,544.72),which was lower than that in the non-cystic group 488.28(321.33,825.97).The difference was statistically significant(Z=-2.147,P=0.032).After matching the patients with measurement of the maximum diameter of the remaining lesion after removal of the gaseous cystic of cystic lung cancer in T1 staging and non-cystic lung cancer in same T1 staging,there was no significant difference between the SII value of 325.82(194.43,544.72)in the cystic group and 431.83(338.62,527.76)in the non-cystic group(Z=-1.321,P=0.186).3.In the cystic group,the 1-year OS and 1-year PFS were 100%,and its 3-year OS and 3-year PFS were 100%.The 1-year OS and 1-year PFS of matched patients in T2 non-cystic lung cancer were 100%and 96.9%,and its 3-year OS and 3-year PFS were 92.5%and 81.5%,respectively.The 1-year OS and 1-year PFS as well as 3-year OS and 3-year PFS of matched patients in T1 non-cystic lung cancer were all 100%.Conclusion:The SII of patients with cystic lung cancer including gaseous cystic computes staging were lower than those of non-cystic lung cancer with the same T staging,and its survival rate were higher than those of non-cystic lung cancer with the same T staging.It may be show that the gaseous cystic in some cystic lung cancer may not be suitable as a basis for T staging.