Analysis Of Characteristics And Risk Factors Of Lung Cancer Associated With Cystic Airspaces

Background:Lung cancer is the leading cause of cancer death among malignant tumors in China and the whole world.In China it is the most common cancer type with highest incidence and mortality,especially since recent years the trend of younger age is becoming more significant among people with lung cancer,which seriously endangering people’s life and aggravates the burden of social economy,having become a public health issue that has attracted great amount of social attention.Data from lung cancer trend reported by WHO CANCER TOMORROW showed a significant increase in lung cancer incidence and mortality in our country from 2020 to 2040 in the population of age over 40-years,while there is a downtrend in the population of age under 40 years.The 5-year survival rate of lung cancer in China is only 19.7%,due to the fact that approximately 70% of lung cancer patients in our country have progressed to advanced stage at the time of diagnosis and lose the chance to receive curative operation,early diagnosis and timely treatment can effectively improve the prognosis of lung cancer patients.Lung cancer of early-stage is mainly manifested as pulmonary nodules,images show pure ground-glass nodules,part-solid nodules and solid nodules,etc.,of which about 2.2% of lung cancer manifested as nodules associated with cystic airspaces.An additional retrospective study of missed lung cancer from the Dutch Belgian randomized controlled lung cancer screening trial(NELSON)showed that 22.7% of missed cases were cystic airspaces associated foci in images.Artificial intelligence(AI)does better in image segmentation,nodule identification,and lung cancer diagnosis with a high accuracy,but for pulmonary nodules associated with cystic airspace,the detection rate was relatively lower in contrast with non-cystic nodules in clinical practice.Therefore,accurately identifying and judging the benign or malignant nature of pulmonary nodules associated with cystic airspace,reducing the rate of missed-diagnosis and misdiagnosis LCCA are of great significance for early diagnosis,improving the prognosis of patient’s survival,and also the poverty caused by illness in family.There are differences in gender and smoking history between LCCA and non-LCCA patients in the population.To explore and analyze the differences between the two types of populations of lung cancer are helpful for accurate identification and diagnosis.The early diagnosis of LCCA is difficult because of missed diagnosis,misdiagnosis and other reasons.Most of the patients are diagnosed with high malignancy in the tumor pathological grades,Therefore,it is important to analyze the characteristics and risk factors of LCCA for accurately identifying this type of lung cancer.The research shows that the density,volume,quality of nodules and their changes with time can be used as early imaging markers for the evaluation of malignant probability.Therefore,the qualitative and quantitative characteristics of imaging are used in our study to analyze invasive adenocarcinoma and non-invasive adenocarcinoma in cystic lung cancer,exploring the population and imaging characteristics of lung adenocarcinoma associated with cystic airspace with different degrees of invasion.Objective:In this study,we retrospectively collected the data of patients of LCCA and non-LCCA to understand the basic characteristics of lung nodules and early lung cancer,and divided lung cancer into LCCA and non-LCCA according to whether the lung nodules were associated with cystic airspaces on imaging,exploring the demographic characteristics,imaging and pathological differences between patients with LCCA and non-LCCA,and to find the risk factors of LCCA.At the same time,aiming at the cystic airspaces associated lung adenocarcinoma in the pathological type,we explored and analyzed the demographic characteristics,imaging,pathological differences and risk factors of invasive lung adenocarcinoma and non-invasive lung adenocarcinoma of LCCA.Although LCCA accounts for a relatively small proportion of lung cancer,but the population base of lung cancer is huge in China,at the same time LCCA has a high degree of pathological malignancy,and the quality of life,prognosis and survival of the patient population,as well as the heavy burden of family disease,has become a serious public health problem,seriously affecting the life and health of the people.This study focuses on accurately understanding the risk factors of patients of LCCA,providing evidence support for the identification and diagnosis of cystic lung cancer in the high-risk population of lung cancer in the future,early diagnosis and treatment would improve the burden of disease and economic and social pressure of health.Methods:From 2017.01 to 2022.01,531 patients with lung nodules and early lung cancer of 580 lung nodules(507 malignant and 73 benign)were collected from the Department of Pulmonary Nodules,Department of Respiratory Medicine,Xijing Hospital.(1)To analyze the general demographic,imaging and pathological characteristics of patients with malignant pulmonary nodules;(2)To compare the difference of detection performance between cystic airspaces associated pulmonary nodules and non-cystic airspace associated pulmonary nodules by AI assisted pulmonary nodule diagnosis software;(3)To analyze the general demographic and imaging characteristics of LCCA and nonLCCA patients,multivariate logistic regression was used to analyze the risk factors of LCCAs;(4)To explore the general demographic characteristics of LCCA and benign lung disease associated with cystic airspaces,and also the demographic characteristics,qualitative and qualitative imaging characteristics of patients with cystic airspaces associated lung adenocarcinoma of different degrees of malignancy,multivariate logistic regression was used to explore the risk factors of lung adenocarcinoma associated with cystic airspaces.Results:(1)Among malignant pulmonary nodules,the proportion of female patients is as high as66.5%,the number of patients in 50-60 age group is the largest(37.7%),the proportion of non-smokers in the lung cancer group is as high as 75.1%,and the proportion of patients with a history of cooking fumes exposure is high(63.3%,321/507).Among the imaging features,the lobe of the lung where lung cancer is located most is right upper lobe,and the proportion of mixed ground-glass nodule(m GGN)is 56.0%,the median density of malignant lung nodules is-506 Hu.In addition,the proportion of adenocarcinoma is 98%,which is mainly in early-stage.(2)The detection rate of pulmonary nodules by AI-assisted pulmonary nodule diagnosis software is 97.1%,but the recognition performance of cystic airspace associated pulmonary nodules is relatively poor.The detection rate of cystic airspace associated pulmonary nodules is only 78.0%,while the detection rate of non-cystic type is 98.9%.(3)There is a significant difference in the characteristics of LCCA and non-LCCA.Among the patients LCCA,the proportion of male is 60.0%,the proportion of smokers and nonsmokers is approximately at the same proportion(51.1%: 48.9%),and the proportion of patients with a history of exposure to cooking fumes is 42.2%.There are statistically significant differences in the above three aspects(P<0.05).Among the CT imaging features,there are statistically significant differences between the two groups in the types of nodules,the largest diameter of the lesions,the attenuation of the lesions,the attenuation ratio of the nodule and lung tissue around the lesions,pulmonary bullae or not,lobulation,spiculation,pleural tag and vessel convergence.Multivariate logistic regression analysis revealed that the lesion’s mean attenuation(OR: 0.985,95% CI: 0.980-0.990,P<0.001)was the protective factor of LCCA,the higher of the mean attenuation,the less possibility of LCCA could be,and the presence of pulmonary bullae(OR: 3.903,95% CI: 1.497-10.175,P<0.001),lobulation sign(OR: 32.486,95% CI: 10.549-100.045,P<0.001)and vessel convergence(OR: 10.030,95% CI: 3.748-26.843,P<0.001)were the risk factors of LCCA.(4)Among 54 cases of cystic airspace associated pulmonary lesions diagnosed by pathology,49 cases were LCCA and 5 cases were benign cystic airspace associated lesions.Univariate analysis showed that the maximum diameter of the lesion,the maximum diameter of the cyst,the volume,the mean attenuation,the mass of the lesion,the m GGN component of the cystic wall,lobulation,spiculation,air bronchogram and the pleural tag were correlated with tumor infiltration(P<0.05).Multivariate logistic analysis found that the mean attenuation of tumor(OR: 1.040,95% CI: 1.008-1.072,P=0.013)and the maximum diameter of cystic airspace(OR: 2.171,95% CI: 1.055-4.467,P=0.035)were the risk factors for the invasion of lung adenocarcinoma associated with cystic airspace.Conclusion:(1)The proportion of female and non-smokers in patients of early-stage lung cancer is high.The proportion of cooking fumes exposure is also at a high level.Most of the lung cancer are in the right upper lobe of the lung,mainly m GGN type,and the pathological type is mainly adenocarcinoma,and most of them are at early-stage.(2)The detection rate of AI-assisted pulmonary nodule diagnosis software is high in the recognition of pulmonary nodules,but the detection performance of nodules with cystic morphology is poor.(3)Among patients with LCCA,the proportion of male patients is high,and the proportion of smoking and non-smoking people is approximately equal in two groups.The multivariate logistic regression analysis revealed that the mean attenuation of the lesion,presence of pulmonary bullae,lobation and vessel convergence were associated with LCCA.While paying attention to early lung cancer screening,it is important to pay attention to the male patient group and identify LCCA for the health and prognosis of lung cancer population.(4)The CT imaging characteristics of lesions with different degrees of pathological invasion in cystic airspace associated lung adenocarcinoma are significantly different.The exploration of multivariate logistic regression analysis found that the mean attenuation of tumor and the maximum diameter of cystic airspace are risk factors for the invasive stage in cystic airspace associated lung adenocarcinoma.Assessing the risk of invasiveness of cystic airspace associated lung cancer can provide reference and help for early intervention and surgical decision-making.