| Objective:To explore the predictive value of circulating tumor cells(CTCs)combined with low-dose helical CT(LDCT)for the pathological invasiveness in malignant solitary pulmonary nodules(MSPNs)and the correlation between CTCs and clinical characteristics of MSPNs patients.Methods:From July 2018 to May 2019,120 consecutive patients with solitary pulmonary nodules(SPNs)detected by LDCT were recruited from the Thoracic Surgery Department of Fujian Provincial Hospital.CTCs was detected by folate receptorαpolymerase chain reaction(FRαPCR)and Cdmax/Td(ratio of the greatest diameter of consolidation found to the greatest diameter of tumor on all LDCT cut)was measured by length of two dimensional measurement preoperatively,the postoperative pathology was taken as the gold standard for the pathological invasiveness in MSPNs,the receiver-operating characteristic(ROC)curve was used to evaluate the predictive value of CTCs for the pathological invasiveness and CTCs combined with LDCT in MSPNs,AUC ranged from 0.50 to 0.70 indicated low predictive value,0.71～0.90 indicated medium predictive value,and 0.91～1.00 indicated high predictive value,c~2test or Fisher’s exact probability method was used to analyze the correlation between CTCs and clinical characteristics of MSPNs patients.Results:In the 120 SPNs cases,102(85%)cases were confirmed as MSPNs,among which 97(81%)cases were lung adenocarcinoma.There were 60 cases of invasive adenocarcinoma(IAC),24 cases of microinvasive adenocarcinoma(MIA)and 13cases of adenocarcinoma in situ(AIS).The level of CTCs of MSPNs containing invasive components(including MIA and IAC)was significantly higher than that of MSPNs without invasive components(AIS)[10.65(9.05～12.70)vs8.00(6.85～10.20)FU/3ml,Z=-3.119,P=0.002].The area under ROC curve(AUC)for CTCs was 0.770,indicated medium predictive value,when the cut-off value of CTCs was 8.45FU/3ml,the sensitivity and specificity was 81.0%(68/84)and 61.5%(8/13)respectively,the area under ROC curve(AUC)of LDCT for predicting whether MSPNs contained invasive components was 0.855,indicated medium predictive value,when the cut-off value was 0.095,the sensitivity and specificity was 77.4%and 92.3% respectively.The area under ROC curve(AUC)for CTC combined with Cdmax/Td indicated high predictive value and it was greater than that of Cdmax/Td(0.914 vs0.855,Z=2.243,P<0.05).Univariate analysis showed that CTCs was significantly associated with tumor maximum diameter on CT,lymph node metastasis and pathological stage in lung adenocarcinoma(c~2=7.118,14.474,4.368,P<0.05),while it had no significant correlation with vascular invasion,pleural invasion and EGFR mutation in malignant nodules(c~2=1.601,0.822,0.457,P<0.05).Conclusions:CTCs have medium predictive value for the pathological invasiveness of MSPNs.The high predictive value of CTCs combined with low-dose helical CT in predicting the pathological invasiveness of MSPNs is better than that of CT imaging alone.CTCs are positive correlated with Td,lymph node metastasis,TNM stage in lung adenocarcinoma,but no significant correlation between CTCs and EGFR mutation in lung adenocarcinoma.It shows that CTCs has application value for early lung adenocarcinoma in auxiliary diagnosis,prediction of prognosis and so on. |
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