Risk Factors And Predictive Model Of Mediastinal Lymph Node Metastasis In Early Non-small Cell Lung Cancer

ObjectiveAt this stage,there is controversy about the operation of lymph node dissection for early non-small cell lung cancer with tumor diameter?3.0cm.The scope and standard of cleaning have not been unified.The preoperative evaluation of the presence or absence of metastases in the mediastinal lymph nodes is used to guide the choice of intraoperative lymph node dissection.Method1.A retrospective study of lymph node metastasis in 216 patients with non-small cell lung cancer with a tumor diameter of?3.0 cm treated by standard surgery in the Department of Thoracic Surgery,Second Hospital of Jilin University from January 2017 to January 2019,collected gender,age,and Family tumor history,smoking history,tumor maximum diameter(mm),tumor solid component maximum diameter(mm),tumor solid proportion,preoperative lymph node diameter(mm),preoperative serum tumor markers,tumor distance from bulge(mm),postoperative paraffin pathological lymph node status and other clinical data,analysis of risk factors of mediastinal lymph node metastasis in patients with non-small cell lung cancer and establish a mathematical prediction model.Patients with non-small cell lung cancer who met the enrollment criteria from January 2019 to April 2019 were enrolled.The model was used to evaluate mediastinal lymph node metastasis before surgery.2.Statistical methods:Statistical analysis was performed using SPSS21.0software.Patients who met the enrollment criteria from January 2017 to January2019 were modeled and statistically analyzed for the above relevant clinical variables and lymph node metastasis.Among them,continuous variables were tested by independent sample T test,and the categorical variables were analyzed by chi-square or Fisher's exact test.P<0.05 was considered statistically significant.Statistically significant variables were included in multivariate binary logistic regression analysis to determine independent risk factors for lymph node metastasis.Mathematical modeling of variables incorporating independent risk factors was performed.The accuracy of the predicted model is estimated by the area under the receiver operating characteristic curve(ROC curve).Patients who met the enrollment conditions during the period of 2019.01-04 were preoperatively predicted by the lymph node prediction mathematical model,and compared with the postoperative pathological gold standard.Therefore,the prediction accuracy of the model is evaluated,which provides a reference for the selection of intraoperative lymph node dissection.ResultsUnivariate analysis of risk factors for mediastinal lymph node metastasis showed whether the tumor markers were abnormal,whether there were lymph nodes greater than 1.0 cm before surgery,the tumor was located at or around the center,the largest diameter of the tumor,the largest diameter of the tumor solid component,and the tumor solid ratio above Statistical significance.Binary logistic regression analysis was performed on the variables in the single factor,and the independent risk factors were identified and finally included in the prediction mathematical model.There were 4 variables:whether the preoperative tumor markers were abnormal,the preoperative lymph node diameter,the tumor distance from the bulge,and the tumor solidity.proportion.Establish a mathematical prediction model of mediastinal lymph node metastasis:e~x/(1+e~x),x=-0.941+0.562*tumor markers+1.974*consolidation/tumor ratio-0.043*tumor distance to the Subcarinal+0.144*preoperative lymph node diameter.The AUC is 0.943(95%CI 0.907-0.98).The model was used to predict the mediastinal lymph node in 39 patients who met the enrollment conditions from January 2019 to April 2019.The accuracy of the prediction was 92.3%.Conclusions1.Independent factors related to lymph node metastasis of non-small cell lung cancer with tumor diameter?3.0cm include:preoperative lymph node diameter,tumor distance from carina,tumor solid ratio,preoperative tumor marker abnormality;2.It is necessary for the evaluation of preoperative lymph nodes in patients with early stage non-small cell lung cancer,combined with the mathematical prediction model of this study:ex/(1+ex),x=-0.941+0.562*tumor markers+1.974*tumor solid ratio-0.043*tumor distance from the bulge+0.144*preoperative lymph node diameter,which can guide the choice of intraoperative mediastinal lymph node and develop a more reasonable treatment plan;3.The conclusions of this study are non-invasive predictive analysis,which has a wide range of applications,light economic burden,and a smooth learning curve can be applied to clinical work,but the clinical pathological results still need to be based on clinical pathological results.