Analysis Of Clinicopathological And Imaging Features Of Solid Or Micropapillary Subtype Of Lung Adenocarcinoma With Diameter ≤ 3cm

Objective: The purpose of this study is to make a retrospective analysis of the clinical,imaging and pathological features of patients with invasive lung adenocarcinoma with micropapillary and solid subtypes and summarize their correlation.It is helpful to improve clinicians’ understanding of solid and micropapillary pathological subtypes of lung adenocarcinoma and to assist in the formulation of treatment strategies.Methods: The data of 311 patients with pulmonary nodules found by chest CT in our hospital from January 1,2016 to October 30,2020 were collected retrospectively,which were resected in thoracic surgery and confirmed to be invasive lung adenocarcinoma by pathology after operation.According to the postoperative pathological subtypes,the patients were divided into two groups: solid or micropapillary group(SLD/MP+),non-solid or micropapillary group(SLD/MP-).Basic clinical data(sex,age,starting respiratory symptoms,history of basic pulmonary disease,previous history of malignant tumor,family history of tumor,smoking history,TNM stage,blood group),chest CT imaging data(nodule location,maximum diameter,marginal features,internal and peripheral features,nodule density),pathological data(pathological subtypes,lymph node metastasis,Ki-67 antigen expression,EGFR mutation status and specific site mutation,ROS-1 fusion gene,ALK fusion gene)were recorded and analyzed by univariate analysis in both groups.The index of P < 0.1 in univariate analysis was included in multivariate binary Logistic regression analysis to identify the independent risk factors of invasive lung adenocarcinoma with solid or micropapillary components.Finally,based on independent risk factors and clinical practicability,the nomogram model was established by using R language software.The efficiency of the model was evaluated by drawing the receiver operating characteristic(ROC),and calculating the area under the curve(AUC).The fitness of the model was evaluated by Hosmer-Lemeshow test.Results: A total of 311 patients were included in this study,including 97 patients in SLD/MP+ group and 214 patients in SLD/MP-group.Univariate analysis of basic clinical data,chest CT imaging data,pathology and driving gene between SLD/MP+group and SLD/MP-group showed that there were significant differences in TNM stage,maximum diameter of nodules,lobulation sign,spiculation sign,nodule density,lymph node metastasis and Ki-67 antigen expression between the two groups(P <0.05).However,there was no significant difference in EGFR,ALK and ROS-1 gene mutation rates between the two groups(P>0.05).The index of P > 0.1 in univariate analysis was included in binary Logistic regression analysis for multivariate analysis.The index of P > 0.1 in univariate analysis was included in multivariate Logistic regression analysis.The results suggested that lobulation sign in CT imaging,higher density of nodules and higher expression of Ki-67 were independent risk factors for invasive lung adenocarcinoma of solid or micropapillary subtype.According to the results of multivariate analysis and clinical practicability,the nomogram model was constructed by combining lobulation sign and nodule density to predict the positive probability of solid or micropapillary pathological subtypes in invasive lung adenocarcinoma.The results showed that the AUC value of the model was 0.735(95%CI:0.675～0.794).The Hosmer-Lemeshow test showed that the model fitted well(P=0.985).Conclusion:1.Compared with SLD/MP-group,SLD/MP+ group had the following clinicopathological features: later TNM stage,larger maximum diameter of nodules,higher incidence of lobulation and spiculation sign,solid nodules,lymph node metastasis and high expression of Ki-67,but there was no significant difference in EGFR,ALK and ROS-1 gene mutation rates between the two groups.2.Lobulation sign in CT imaging,higher density of solid components and high expression of Ki-67 were independent risk factors for invasive lung adenocarcinoma of solid or micropapillary subtype.3.The prediction model constructed by the combination of lobulation sign and nodule density has a certain predictive value for invasive lung adenocarcinoma of solid or micropapillary subtypes,which can provide some reference for the treatment strategy of patients.