Correlation Analysis Of Clinical Features And Prognosis Of Pathological Stage IA Invasive Lung Adenocarcinoma

Objective:With the deepening of people’s attention to health and the continuous development of medical-related technology and equipment,more patients with early-stage lung cancer have been effectively treated.Early invasive lung adenocarcinoma usually has a good prognosis after surgical treatment,but there are certain differences among different pathological subtypes.This article analyzes and discusses the factors influencing the prognosis of pathological stage IA invasive lung adenocarcinoma and the differences in clinical characteristics among different pathological subtypes,so as to provide references for clinical diagnosis and treatment.Methods:A total of 435 patients with invasive lung adenocarcinoma whose postoperative pathology was confirmed to be stage IA after undergoing surgical treatment at the Thoracic Surgery Department of the Clinical Medical College of our school from January 2013 to December 2018 were collected.The pathological classification and diagnostic criteria were strictly in accordance with the standard proposed by the World Health Organization in 2015.According to the new criteria proposed by the organization,patients are divided into six groups:adherent type,acinar type,papillary type,micropapillaryza type,solid type and variant type.Collect clinical characteristics data(including general clinical data,imaging data,pathology and laboratory examination data and follow-up data,etc.)of patients with stage IA invasive lung adenocarcinoma who meet the enrollment criteria for retrospective analysis to explore the risk factors that affect the patients’ prognosis and differences in clinical characteristics among different pathological subtypes.At the same time,follow-up methods such as telephone inquiry,outpatient review status system inquiry and medical record room archive data inquiry are used to understand whether the patients have recurrence and metastasis after surgery.The endpoint of the study is the patients’ recurrence,metastasis,death or last follow-up.The follow-up time is up to the end of December 2020.Explore the correlation between the clinical characteristics and the recurrence and metastasis of patients after surgery,screen out the influencing factors that may be related to the prognosis and do further research,and analyze and compare the differences in clinical characteristics among different pathological subtypes.All statistical data are analyzed by SPSS 22.0.Results:A total of 435 patients with pathological stage IA invasive lung adenocarcinoma who met the enrollment criteria were included in this study.The analysis showed that the risk factors related to recurrence and metastasis were age(P=0.011),smoking history(P=0.001),T stage(P=0.028),family history(P=0.006),type of pathological subtype(P=0.018),numbers of pathological subtypes contained(P<0.001),micropapillary components(P<0.001),solid components(P<0.001),containing micropapillary or solid components(P<0.001),neutrophil-to-lymphocyte ratio(P<0.001),platelet-to-lymphocyte ratio(P=0.020),the level of carcinoembryonic antigen(P<0.001)and the level of cytokeratin-19-fragment(P=0.016).Univariate COX regression analysis showed that age(P=0.014),smoking history(P=0.001),T stage(P=0.017),family history(P=0.002),type of pathological subtype(P=0.024),numbers of pathological subtypes contained(P<0.001),micropapillary components(P<0.001),solid components(P<0.001),neutrophil-to-lymphocyte ratio(P=0.001),the level of carcinoembryonic antigen(P<0.001)0.001)and the level of cytokeratin-19-fragment(P=0.012)significantly affect disease-free survival rate of patients,age(P=0.012),smoking history(P=0.007),family history(P=0.010),type of pathological subtype(P=0.043),numbers of pathological subtypes contained(P=0.001),micropapillary components(P<0.001),solid components(P<0.001),the level of carcinoembryonic antigen(P=0.001)and the level of Cytokeratin-19-fragment(P=0.002)significantly affect the overall survival rate of patients.The multivariate COX regression analysis was further included,and the age(P=0.026),numbers of pathological subtypes contained(P=0.004),the micropapillary components(P=0.001)and the solid components(P=0.031)were found to be the independent risk factors that affect the disease-free survival rate of patients,age(P=0.009)and the micropapillary components(P=0.001)are independent risk factors that affect the overall survival rate of patients.The Kaplan-Meier survival analysis curve shows that the older the age,the history of smoking,the higher the T stage,the family history,the greater the number of pathological subtypes,the micropapillary components,the solid components,the higher the neutrophil-to-lymphocytes ratio,the patients with positive carcinoembryonic antigen and positive cytokeratin-19-fragment have a worse prognosis.The 5-year disease-free survival rate and overall survival rate of stage IA invasive lung adenocarcinoma were 77.4%and 86.5%respectively.The prognosis of different pathological subtypes is different.The 5-year disease-free survival rates of adherent,acinar,papillary,micropapillary,solid and variant types were 95.2%,79.0%,81.4%,67.8%,66.3%and 74.9%,respectively.The 5-year overall survival rates were 98.1%,93.2%,89.3%,80.7%,79.6%and 78.2%,respectively.Chi-square test or Fisher’s exact test can be used to obtain that there are significant differences in different pathological subtypes in smoking history(P=0.034),T stage(P=0.010),family history(P<0.001),numbers of pathological subtypes contained(P<0.001),Neutrophil-to-lymphocyte ratio(P<0.001),the level of carcinoembryonic antigen(P=0.017),imaging manifestations of lobular signs(P=0.041),burr signs(P=0.015)and pleural depression signs(P=0.033).Further analysis showed that compared with other subtypes,the two pathological subtypes of micropapillary type and solid type have a higher proportion of those with a history of smoking,those with higher T stage,and those with a higher ratio of neutrophils-to-lymphocytes.Micropapillary,solid and variant types are significantly higher in the number of patients with positive carcinoembryonic antigen,family history and more pathological subtypes than the number of adherent,acinar and papillary types,and are easier to perform in imaging with lobular signs,burr signs and pleural depression signs.Conclusion:1、Age,smoking history,T stage,family history,type of pathological subtype,numbers of pathological subtypes contained,micropapillary components,solid components,containing micropapillae or solid components,neutrophil-to-lymphocyte ratio,platelets-to-Lymphocyte ratio,the level of carcinoembryonic antigen,and the level of cy tokeratin-19-fragment are related to the prognosis of stage IA invasive lung adenocarcinoma.2、Age,numbers of pathological subtypes contained,micropapillary components and solid components are independent risk factors that affect the patient’s disease-free survival rate,and age and micropapillary components are independent risk factors that affect the overall survival rate of patients.3、There are certain differences in the prognosis and clinical characteristics of different pathological subtypes.In general,the adherent type has the best prognosis,followed by the papillary and acinar types,while the micropapillary,variant,and solid types have poor prognosis,and the clinical features of them are more inclined to show malignant signs.