Prognostic Outcomes Of Surgical Resection For 90 Cases Stage Ⅰ Lung Adenocarcinoma With Radiologic Characteristic Of Subsolid Pulmonary Nodules

Objective: To explore the imaging features of stageⅠlung adenocarcinoma with radiologic characteristic of sub-solid pulmonary nodules, and analyze its difference from benign sub-solid nodules, and provide a reference for the differential diagnosis of benign and malignant nodules. With a retrospective analysis of these lung ad enocarcinoma patients’ clinical characteristics and prognostic factors, it studied the relationship between the proportion of solid tumor component(C/T ratio, consolidion to tumour)and patients’ prognosis.Methods: By collecting clinical data of 90 patients treated in Department of Thoracic Surgery of the First Affiliated Hospital of Dalian Medical University from January 2008 to December 2010, who had been confirmed with stageⅠlung adenocarcinoma through surgery and pathology, and whose CT images showed s ubsolid nodules. The follow-up visit strategie adopted was that, for the first year after surgery, a follow-up visit carried out in every three months;for the second year, every six months; starting from the third year, in each year until December 2014.To acquire the survival conditions and relevant clinical information such as physical examination, blood biochemistry, tumor markers, chest and abdominal C T, whole-body bone scan or PET-CT examination results of these patients. Imaging information of another 76 patients treated in our hospital from January 2012 to December 2014 was collected as control group, who had characteristic of mixed GGN(ground-glass nodules) and then been confirmed with benign pulmonary nodules through surgery and pathology. And it utilized chi-square test to statistically ana lyze sixsets of data such as C/T ratio, spiculation, lobulation sign, pleural indentation, air-bronchogram, vascular convergence sign, and to check whether these data would have any difference in differentiating benign and malignant nodules. Then it retrospectively analyzed the clinical and pathological data of patients with lung adenocarcinoma, and based on patient living situation, assessed how were these patients’ long-term survival impacted by various clinical factors, such as gender, age, surgical approach, differentiation degree, tumor solid component ratio(C/T ratio) and various imaging features, etc.All these data were analyzed through SPSS20.0 software, only when P<0.05, it would be considered as statistically significant. The receiver operating(ROC) curve was drawn to determine the optimal cut-off point.Kaplan-Merier univariate analysis Log-rank method was used so as to evaluate the differences between- group and eventually survival curves were plotted.Result: Among 90 cases,male accounted for 37.8%,female accounted for 62.2%; age-bracket 53-82,median ages 62; pulmonary lobectomy accounted for 80.0%,sublobar resection accounted for 14.4%,others accounted for 5%; High differentiation adenocarcinoma accounted for 72.2%, middle differentiation accounted for 15.6%, low differentiation accounted for 35.6%; speculation sign accounted for 77.8%, lobulation sign 74.4%, pleural indentation 23.3%, air-bronchogram 28.9%, vascular convergence sign 17.8%.The receiver operating characteristic(ROC) curve shows that in the the C/T ratio of distinction between lung cancer nodules and benign nodules, the largest area under the curve(AUC) was 0.73, and 95% confidence interval(CI) was 0.69-0.80, indicating that this experiment has a certain accuracy, and the optimal cut-off point(COP) was about 0.50. There were differences between of benign and malignant groups in terms of C/T ratio, the existence of lobulation, spiculation air-bronchogram, which was statistically significant, P<0.05. Kaplan-Merier univariate analysis showed that, C/T ratio is a factor affecting the prognosis of stage I lung adenocarcinoma. The five-year survival rate of patients with C/T ratio 0.5 or more was significantly lower than C/T ratio 0.5 or less which were 40.1% and 84.3%, respectively, P<0.05.Conclusion: C/T ratio, lobulation, and speculation are the differential points of benignsolid nodules and lung nodules. C/T ratio is a factor affecting the prognosis of stage I lung adenocarcinoma with rad iologic characteristic of subsolid pulmonary nodules.