| Objectives:Lung cancer is the leading cause of cancer deaths worldwide.In China,the incidence and mortality rate of lung cancer is the highest among all cancer types.With the popularity of high-resolution CT and increased public health awareness,more and more lung adenocarcinoma patients with Ground glass opacity(GGO)are being detected during health screening,becoming the main group of lung cancer surgical consultations.The predominant pathological subtypes are lepidic and acinar,with a higher rate of EGFR-positive mutations,and are more common in non-smoking women.GGO featured lung adenocarcinoma can develop early in life as multifocal ground glass nodules(m GGNs).m GGNs are more common in women and their cause is not known.A growing body of research suggests that estrogen and its pathways play an important role in the development and progression of lung cancer.In this study,we compared serum estradiol(E2)levels,estrogen receptor β(ERβ)and aromatase(ARO)expression levels in tumor tissues of patients with GGO featured lung adenocarcinoma to investigate their differences between clinicopathological characteristics and the relationships with multifocal development.Methods:Information on 302 patients who were treated surgically in our department from July 2020 to March 2022 and had blood samples preoperatively was reviewed.96 patients were finally selected for inclusion in the follow-up study based on the nadir criteria.Patients’ gender,age,smoking history,single/multiple ground glass nodules,pathological stage,pathological subtype,pathological grade,Ki-67,consolidation tumor ratio(CTR)and mean CT value were counted.For patients with multiple ground glass nodules,pathological and imaging indices were selected from the primary lesion for measurement.The expression of ARO and ERβ in the tumor tissue was measured using immunohistochemical staining,and the average opacity density(AOD)value was measured using Image J software as a semi-quantitative indicator of the expression levels of the two proteins in the tumor tissue.The differences in serum E2,ARO and ERβ were compared between the clinicopathological data groups.Results:1.The level of ARO expression in the tumor tissue of the main lesion of multiple ground glass nodules was significantly higher than that of single ground glass nodules(p=0.008).2.ERβ expression levels in tumor tissue differed between the three pathological subtypes: lipidic,acinar and papillary(p<0.05),with ERβ expression levels significantly higher in tumor tissue with a papillary subtype than in lesions with an lipidic subtype(p<0.05).3 Pathological grading Grade 2 had higher ERβ expression levels than Grade 1,and the difference was statistically significant(p<0.05).4 There was a difference in ERβ expression levels in each subgroup of Ki-67(p <0.05).When compared between two,ERβ expression was significantly lower in the Ki-67(10%-20%)group than in Ki-67(<5%)(p<0.01).Using the Spearman correlation test,there was a negative correlation(r =-0.306,p < 0.01).5.In the male subgroup,there was a statistically significant difference between the high and low serum E2 level groups in terms of smoking history(p < 0.05).Conclusion:1.There was a significant difference in ARO expression levels in tumor tissues of patients with single and multiple ground glass nodules,and high ARO levels leading to elevated local E2 levels may contribute to the multifocal development of ground glass nodules.2.ERβ expression levels in tumor tissues were associated with worse pathological subtypes,higher pathological grade,and lower Ki-67.3.In male patients,a history of smoking is associated with higher serum E2 levels. |
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