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| Analysis of independent risk factors for non-solid pulmonary nodules and establishment of a benign and malignant predictive model#br# |
| LIU Canjun1 ZHAO Jiaying1 WANG Jian2 |
1.Medical College, Jiangsu University, Jiangsu Province, Zhenjiang 212000, China;
2.Department of Respiratory, the First People’s Hospital of Zhenjiang, Jiangsu Province, Zhenjiang 212002, China |
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Abstract Objective To screen independent risk factors for non-solid pulmonary nodules and establish a predictive model for benign and malignant pulmonary nodules. Methods The clinical data of 309 patients with non-solid pulmonary nodules diagnosed in the First People’s Hospital of Zhenjiang, Jiangsu Province from 2015 to 2020 were retrospectively analyzed, and they were divided into observation group (malignant, 61 cases) and control group (benign, 248 cases) according to benign and malignant of the nodules. Single factor and binary logistic regression were used to analyze the risk factors in malignant nodules, and a prediction model was established. The diagnostic value of the model was analyzed by the receiver operation characteristic curve. Results Age, carcinoembryonic antigen (CEA) level, nodule diameter, solid part length diameter, mean CT (m-CT) value, and the proportions of calcification, vascular sign, vacuole sign, lobulation sign, and spicule sign in the observation group were higher than those in the control group, and the differences were statistically significant (P ＜ 0.05). Multivariate analysis showed that high CEA level, long solid part length diameter, high m-CT value, and vascular sign, vacuolar sign, lobulation sign, and spicule sign were independent risk factors for malignant non-solid pulmonary nodules (OR ＞ 1, P ＜ 0.05). The prediction model was P = ex/(1 + ex), x=-6.078 + (2.002 × spicule sign) + (3.438 × vacuole sign) + (3.877 × vascular sign) + (0.622 × CEA) + (0.149 × solid part length diameter) +(0.003 × |m-CT|) + (5.494 × lobulation sign). The area under the curve of the model was 0.882 (P < 0.05), and the cut-off value was 0.842. Conclusion The benign and malignant prediction model of nonsolid pulmonary nodules is established in this study, which has certain diagnostic value and great clinical application prospect for benign and malignant diagnosis.
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[1] GBD 2016 Occupational Carcinogens Collaborators. Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens：a systematic analysis for the Global Burden of Disease Study 2016 [J]. Occup Environ Med，2020，77（3）：151-159.
[2] Barta JA，Powell CA，Wisnivesky JP. Global Epidemiology of Lung Cancer [J]. Ann Glob Health，2019，85（1）：8.
[3] Blandin Knight S，Crosbie PA，Balata H，et al. Progress and prospects of early detection in lung cancer [J]. Open Biol，2017，7（9）：170070.
[4] Ye T，Deng L，Wang S，et al. Lung Adenocarcinomas Manifesting as Radiological Part-Solid Nodules Define a Special Clinical Subtype [J]. J Thorac Oncol，2019，14（4）：617-627.
[5] Renda SW，Michael KG，Douglas AA，et al. An official American Thoracic Society/American College of Chest Physicians policy statement：implementation of low-dose computed tomography lung cancer screening programs in clinical practice [J]. Am J Respir Crit Care Med，2015， 192（7）：881-891.
[6] Swensen SJ，Silverstein MD，Ilstrup DM，et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules [J]. Arch Intern Med，1997，157（8）：849-855.
[7] Gould MK，Ananth L，Barnett PG，et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitarypulmonarynodules [J]. Chest，2007，131（2）：383-388.
[8] Li Y，Hu H，Wu Z，et al. Establishment of a mathematical prediction model to evaluate the probability of malignancy or benign in patients with solitary pulmonary nodules [J]. Biosci Rep，2020，40（2）：BSR20193875.
[9] Snoeckx A，Reyntiens P，Desbuquoit D，et al. Evaluation of the solitary pulmonary nodule：size matters，but do not ignore the powerof morphology [J]. Insights Imaging，2018， 9（1）：73-86.
[10] Eisenberg RL，Bankier AA，Boise Ue PM． Compliance with Fleischner Society guidelines for management of small lung nodules：a survey of 834 radiologists [J]. Radiology，2010，255（1）：218-224.
[11] 高万春，李小军，谭斌彬，等.CT引导下穿刺活检对不同大小孤立肺结节灶的结果研究[J].河北医学，2020， 26（7）：1192-1195.
[12] Aritoshi H，Takeshi M，Kazuya T，et al. Neither Maximum Tumor Size nor Solid Component Size Is Prognostic in Part-Solid Lung Cancer：Impact of Tumor Size Should Be Applied Exclusively to Solid Lung Cancer [J]. Ann Thorac Surg，2016，102（2）：407-415.
[13] Yip R，Li K，Liu L，et al. Controversies on lung cancers manifesting as part-solid nodules [J]. Eur Radiol，2018， 28（2）：747-759.
[14] 中华医学会呼吸病学分会肺癌学组与中国肺癌防治联盟专家组.肺结节诊治中国专家共识（2018年版）[J].中华结核和呼吸杂志，2018，41（10）：763-771.
[15] Sánchez M，Benegas M，Vollmer I. Management of incidental lung nodules ＜8 mm in diameter [J]. J Thorac Dis，2018，10（22）：S2611-S2627.
[16] 唐铷，吕梦媛，周健，等.肺磨玻璃结节影像学特征与肺腺癌预后关系的研究进展[J].中国胸心血管外科临床杂志，2019，26（12）：1252-1257.
[17] 钟明浩，侯文忠，范晓东.孤立性肺结节的动态CT增强扫描特征分析[J].中国当代医药，2020，27（20）：171-174.
[18] 李西，范丽，肖湘生.肺部纯磨玻璃结节的CT研究进展[J].国际医学放射学杂志，2016，39（1）：31-34.
[19] 胡军，王晓冬.济南市区域成年健康查体人群胸部CT检出肺局灶性磨玻璃密度结节情况[J].中国临床研究，2021，34（9）：1190-1193，1198.
[20] Jesper HP，Zaigham S，Mathilde MWW，et al. Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening：Radiology，Pathology，and Clinical Management [J]. Oncology（Williston Park），2016，30（3）：266-274.
[21] Gao F，Li M，Ge X，et al. Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels [J]. Eur Radiol，2013，23（12）：3271-3277.
[22] Wang XH，Leader JK，Wang RW，et al. Erratum to“Vasculature surrounding a nodule：A novel lung cancer biomarker” [J]. Lung Cancer，2019，135：234.
[23] Qi L，Xue K，Li C，et al. Analysis of CT morphologic features and attenuation for differentiating among transient lesions，atypical adenomatous hyperplasia，adenocarcinoma in situ，minimally invasive and invasive adenocarcinoma presenting as pure ground-glass nodules [J]. Sci Rep，2019，9（1）：14586.
[24] Yanagawa M，Kusumoto M，Johkoh T，et al. Radiologic-Pathologic Correlation of Solid Portions on Thin-section CT Images in Lung Adenocarcinoma：A Multicenter Study [J]. Clin Lung Cancer，2018，19（3）：e303-e312.
[25] 刘宁.肺磨玻璃结节患者浸润性病变及间变性淋巴瘤激酶基因突变的影响因素分析[J].中国当代医药，2020， 27（15）：15-19，253.
[26] 李镇江，赵杰，贾晓民.肿瘤标志物和CT联检对早期肺腺癌诊断价值[J].临床肺科杂志，2019，24（8）：1484-1488.
[27] Zheng J，Ye X，Liu YA，et al. The combination of CTCs and CEA can help guide the management of patients with SPNs suspected of being lung cancer [J]. BMC Cancer，2020，20（1）：106.
[28] Yu JF，Sui AX. MiRNA-30 Play an Important Role in Non-Small Cell Lung Cancer （NSCLC）[J]. Clin Lab，2020，66（4）.
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