Differences In Hematological Parameters Between Patients With Pulmonary Malignant Solitary And Multiple Ground-glass Nodules

ObjectiveLung cancer is the leading cause of cancer-related death worldwide.Non-small cell lung cancer accounts for 85% of lung cancer cases.Many non-small cell lung cancers are characterized by ground-glass nodules in the early stage.Increased pulmonary ground-glass nodules through examination,20% to 30% of which with more than one lesions.At present,studies between solitary and multiple GGNs are mainly focused on the difference in treatment regimens and genes.However,the specific mechanism of different numbers of lesions remains unclear,and there is no related research on the difference of hematological parameters,either.Since development of GGNs and the possible omission of GGNs caused by less conspicuous lesions might have an impact on the decision making of follow-up treatment plans,this article is aim to explore the potential diagnostic value of the routine blood test parameters and systemic inflammatory response indexes based on it between patients with malignant solitary and multiple GGNs,and speculate the possible reason of the different number of lesions.MethodsA retrospective analysis was made based on the data of 222 patients with GGNs admitted to the Department of Thoracic of the Jilin University First Hospital from January 2018 to January 2020.Patients are divided into solitary GGN group(n=147)and multiple GGNs group(n=75)depending on the number of lesions.At least one GGN of each patient was pathologically proved to be malignant.The age,gender,liver function,blood routine,and coagulation routine before treatment were collected,and the systemic inflammatory response indexes such as HRR,PLR,and NLR were also calculated.Independent sample t-test,Mann-Whitney U test,chi-square test,and logistic regression analysis are performed in SPSS 22.0 software for univariate analysis of two groups of patients.The selected factors were adjusted by gender and age,and the best cut-off values were determined by the ROC curves.The accuracy of the relevant indicators to distinguish between the two groups of patients was compared.The independently associated factors of multiple GGNs were further determined according to logistic multiple regression analysis.The differences in systemic inflammatory response indexes of patients grouped by HRR was also compared.Results1 、 In univariate analysis,compared to solitary GGN patients,multiple GGNs patients have a significantly higher proportion of females(P<0.001)and raised RDW level(P=0.002),while decrease in level of hemoglobin(P=0.004)and HRR(P<0.001).2、With the adjustment by age and gender,increased RDW level(OR=1.725,95%CI: 1.11-2.68,P=0.015)and decreased HRR level(OR=0.702,95%CI:0.534-0.924,P=0.012)could still be observed in multiple GGNs patients.3 、 ROC curves show a better diagnostic value of HRR than RDW with or without the union of gender and age.4、In the multifactor analysis,HRR was found to be independently associated with multiple GGN(OR=0.706,95%CI: 0.530-0.940,P=0.017).5、In the comparison between groups divided by the best cut-off value of HRR,patients with lower HRR level turned out to have higher proportions of females(P<0.001)and patients with multiple GGNs(P<0.001),and decrease in HALP level(P<0.001)is also significant.Conclusion1 、 Compared to solitary GGN patients,multiple GGNs patients have a significantly decreased hemoglobin level,raised RDW level,and decreased level of HRR.2、Decreased HRR level is independently associated with multiple GGNs.