Research Of Personality Traits And Hormonal Correlations With The Nature Of Small Pulmonary Nodules

The incidence of lung cancer is increasing yearly while ranking the highest mortality rate among all malignancies,becoming a significant public health problem.In the tertiary preventive treatments of lung cancer,it is emphasized that the earlier lung cancer is detected and corresponding treatment measures are taken,the better the prognosis will be.In the current clinical consensus,the early detection of lung cancer mainly relies on imaging screening,and with the broad utilization of modern high-resolution CT,more and more small pulmonary nodules（≤3 cm in diameter）are being detected in the health screening of lung cancer,which makes the differentiation of benign and malignant small pulmonary nodules an essential task.Hence,assessing potentially malignant small pulmonary nodules is challenging and critical for further follow-up and treatment.Some studies have shown that patients’personality is associated with tumor and their changes and progression since hormones would regulate specific signaling pathways during tumor development,thereby influencing the course of the tumor.Therefore,we envisage conducting a personality questionnaire survey on patients with small pulmonary nodules and testing their hormone levels.With the data we have got,we use statistical methods to analyze the correlation between personality traits,hormones and the benign and malignant nature of small pulmonary nodules,trying to explore the value of personality traits and hormones in assessing the benign and malignant nature of small pulmonary nodules,and therefore better guiding the clinical decision-making of lung cancer.METHODS:1.The research subjects were patients who were hospitalized in the Department of Thoracic Surgery of our hospital from 01/01/2021 to 06/30/2022 and were diagnosed as pulmonary nodules.Inclusion criteria:（1）patients with pulmonary nodules diagnosed for the first time and CT showed small pulmonary nodules（≤3 cm in diameter）;（2）patients with a single nodule or multiple isolated nodules;（3）patients who were hospitalized for surgery and obtain pathological results;（4）patients agreed to participate in this topic research.Exclusion criteria:（1）patients with metastases of other organs;（2）patients whose nodule had been operated;（3）those who cannot complete the investigation due to mental illness or other reasons;（5）those who refuse to participate in questionnaire investigation or refuse to undergo serum hormone testing.2.Patients included in the research were surveyed by using a type C behavioral scale,preoperative venous blood was collected after admission,and serum hormones（androgens testosterone,estradiol,estriol,thyroid hormone T₃,thyroid hormone T₄）were measured with ELSIA kits.Then the baseline clinical data of the patients were collected through the database,including age,sex,postoperative pathological results,nodule average imaging density,nodule diameter,CT value,smoking history,tumor history and menstrual history of female patients.3.The patients were divided into two groups according to the benignity or malignancy of postoperative pathological results.Statistical analysis was performed on baseline data,questionnaire results and hormone test results by using independent samples t-test and chi-square test.Further multivariate logistic regression was performed to screen the risk factors of malignant small pulmonary nodules.According to the evaluation criteria of the questionnaire and the corresponding reference values,a one-sample t-test was performed on the results of personality traits grouped by gender,and the adverse factors of personality traits on small pulmonary nodules in different genders were screened.Finally,for the patients whose pathological results was adenocarcinoma,the data were analyzed to see if they meet the conditions of the ordered logistic regression analysis,and then the ordered logistic regression analysis was performed to screen the influencing factors of pathological grade of adenocarcinoma.RESULTS:1.316 subjects were included in the personality scale survey,with an age range of 25-84 years,including 3 patients over 80 years old,40 cases aged 70-79,accounting for 12.66%,273 patients under 70 years old,accounting for 86.39%.There were 139 male aged（60.43±10.45）years old and 177 female aged（56.14±11.07）years old.There were 234 cases never smoked,accounting for 74.05%,37 case once smoked and had currently quit so far,and 45 cases kept smoking all the time.The diameter of nodules in all the patients in the study was≤3cm,and the multiple nodules were calculated and analyzed according to the largest nodule treated by surgery.After excluding non-menopausal women,hormone testing was performed on a total of 245 preoperative serum specimens collected from patients,including 128 men aged（60.21±10.64）years old and 117 women aged（61.21±7.14）years old.2.Correlation between personality traits and the nature of small pulmonary nodules（1）The risk factors of malignant small pulmonary nodules showed significant differences between gender（χ²=4.89,P=0.027）,nodule average imaging density（χ²=44.02,P=0.000）,CT value（t=-5.19,P=0.000）,anger（t=2.27,P=0.024）,anger inwards（t=2.32,P=0.021）in a univariate statistical analysis;nodule average imaging density and anger inwards（P=0.022;OR=1.186;95%CI:1.025-1.372）were statistically different（P<0.05）in the multifactorial analysis.Compared to pure ground glass nodules,mixed ground glass nodules（OR=1.312;95%CI:0.315-5.460）are at higher risk of malignancy but solid nodules（OR=0.109;95%CI:0.315-5.460）are at lower risk of malignancy.（2）According to gender group,the personality score of nodule pathology with lung cancer was compared with the corresponding norm reference value of the scale,depression（t=4.43,P=0.000）,anger outwards（t=-14.03,P=0.000）,optimism（t=-3.45,P=0.001）,and social support（t=-8.35,P=0.000）of men;and depression（t=4.98,P=0.000）,anger outwards（t=-12.79,P=0.000）,optimism（t=-3.40,P=0.001）,and social support（t=-7.62,P=0.000）of women;the scores of all these items were statistically different（P<0.05）.（3）The analysis of influence factors of pathological grading of lung adenocarcinoma showed that there were statistically differences（P<0.05）in nodules average imaging density,nodules diameter,and CT values of nodules.There were no statistical differences（P>0.05）between personality traits and the pathological grading of adenocarcinoma.3.Correlation between hormones and the nature of small pulmonary nodules（1）The risk factors of malignant small pulmonary nodules showed statistical differences between nodule average imaging density（χ²=28.30,P=0.000）,CT value（t=-3.04,P=0.003）,androgen testosterone（t=-2.27,P=0.027）,thyroid hormone T₄（t=2.67,P=0.008）in the univariate analysis;multifactorial analysis of nodule average imaging density and thyroid hormone T₄（P=0.004;OR=1.015;95%CI:1.005-1.025）were statistically different（P<0.05）.Compared to pure ground glass nodules,mixed ground glass nodules（OR=1.380;95%CI:0.253-7.532）are at higher risk of malignancy but solid nodules（OR=0.109;95%CI:0.023-5.06）are at lower risk of malignancy.（2）The analysis of influence factors of pathological grading of lung adenocarcinoma showed that there were statistical differences（P<0.05）in nodules average imaging density,nodules diameter and CT values.There were no statistical differences between hormone levels and pathological grading of adenocarcinoma（P>0.05）.3.Correlation analysis of personality and hormones with the nature of small pulmonary nodulesResults based on statistical linear correlation analysis,there was no statistical linear relationship between personality and hormone levels.After including personality and hormones together,it was analyzed the risk factors,the results showed that nodule average imaging density（P<0.05）and thyroid hormone T₄（P=0.012）were the risk factors of the nature of nodules.Conclusions1.Personality traits can affect the nature of nodules,when evaluate small pulmonary nodules in clinical diagnosis and treatment,we should pay attention to the personality characteristics of patients,especially for the patients with small pulmonary nodules detected in the initial screening,and carry out some targeted mental health interventions,which should have positive significance for possibly changing the malignant progression of small lung nodules.2.The imaging features of nodules（nodules diameter、nodules average imaging density、CT value）are influence factors of pathological grade of lung adenocarcinoma,and thyroid hormone T₄ is an independent risk factor for small pulmonary nodules.3.There is no statistical linear relationship between personality traits and hormones,and the joint role of the two on the nature of small pulmonary nodules needs to be further explored and elucidated.