Analysis Of Clinical Features Of Different Pathological Subtypes Of T1 Invasive Lung Adenocarcinoma

Objective:To investigate whether there are differences in the clinical features of different pathological subtypes of T1 invasive adenocarcinoma,And analyze the risk factors associated with micropapillary pattern lung adenocarcinoma,so as to screen out the indicators with identification significance.Methods:A total of 96 patients with T1 invasive lung adenocarcinoma admitted to the Department of Thoracic Surgery,Second Affiliated Hospital of Kunming Medical University from April 2015 to December 2018 were enrolled.According to the latest classification of lung tumor histology published by the World Health Organization(WHO)in 2015,invasive lung adenocarcinoma is divided into five groups:lepidic group,acinar group,papillary group,solid group,micropapillary group.According to whether invasive lung adenocarcinoma is associated with micropapillary pattern,it is divided into MPP positive group and MPP negative group.Single factor analysis was performed for patients with clear pathological characteristics on the following factors:age,gender,smoking history,lesion location,lesion size,lymph node metastasis,proportion of solid components,signs of MSCT scan(lobulation,spiculation,pleural indentation,air bronchogram,vascular convergence sign),tumor markers(CEA),coagulation parameters(PLT,FIB,DD,FDP).The ANOVA was used for measurement data,the chi-square test and rank sum test was performed for categorical data.ROC curve based on the frequency of statistically significant signs in the MPP group.Binary logistic regression analysis was used to screen out the relevant risk factors associated with MPP.SPSS24.0 Software was used for all statistical analysis.P<0.05 was considered statistically significant.Results:1.Comparison of clinical features of five major pathological subtypes:Of the 96 patients,53 were male and 43 were female,with an age range of 30 to 79 years and an average age of 58.08 ± 1.97 years.There were 7 cases of adherent type,44 cases of acinar type,16 cases of papillary type,23 cases of solid type and 6 cases of micropapillary type.There were no significant differences in age,gender,smoking history,lesion location,and lesion size among the five pathological subtypes(P>0.05).The lymph node metastasis and the proportion of solid components were statistically significant in different pathological grades(P<0.05).The grade 3 group is more prone to lymph node metastasis than the grade 1 and grade 2 groups,The proportion of solid components in the first-grade group was less than that in the 2nd and 3rd groups.Lymph node metastasis and the proportion of solid components in the lesion were positively correlated with pathological grade.The higher the tissue level of lung adenocarcinoma,the greater the proportion of solid components,the more likely lymph node metastasis.The positive detection rate of spiculation,pleural indentation,vascular convergence sign,CEA,PLT and FDP was not statistically significant among the five pathological subtypes(P>0.05).The positive detection rate of lobulation,air bronchogram,FIB and D-D was statistically significant among the five pathological subtypes(P<0.05).The incidence rate of solid type lobulated sign was higher than that of papillary type and lepidic type,and the difference was statistically significant(P<0.005);The incidence of acinar air bronchogram was lower than that of solid type,and the difference was statistically significant(P<0.005).The positive detection rate of micropapillary FIB was basically the same as that of solid type,and the detection rate of micropapillary FIB was significantly higher than other pathological subtypes,and the difference was statistically significant(P<0.005).The positive rate of micropapillary D-D was higher than that of acinar type,and the difference was statistically significant(P<0.005).2.MPP negative group compared with MPP positive group:Of the 96 patients,21 were in the MPP-positive group and 75 in the MPP-negative group.The five signs positive detection rate of lobulation,air bronchogram,CEA,FIB and D-D was statistically significant in the MPP group(P<0.05),and the MPP positive group was higher than the MPP negative group.The ROC curve shows that there are more likely to have MPP in the presence of more than three malignant signs.Binary logistic regression analysis showed that CEA(OR=4.246,P=0.033),FIB(OR=6.690,P=0.005),D-D(OR=6.915,P=0.004)were associated risk factors associated with MPP.Conclusions:1.There are some differences in clinical features between different pathological subtypes of T1 invasive lung adenocarcinoma.The higher the tissue level of lung adenocarcinoma,the higher the detection rate of malignant signs in clinical features,the greater the proportion of solid components in the lesions,the more likely lymph node metastasis to occur.2.In T1 invasive lung adenocarcinoma,when nodules with suspected MPP are suspected,when the malignant signs of nodules are>3,the nodules are more likely to have MPP.CEA,FIB,and D-D are related risk factors associated with MPP.