Background: Lung cancer is still the malignant tumor with the highest morbidity and mortality in China. Lung adenocarcinoma is the most common subtype, and the number of lung cancer presenting as mixed ground glass nodule (mGGN) in imaging is gradually increasing. Visceral pleural invasion (VPI) is an important factor affecting the prognosis of mGGN type lung adenocarcinoma. The aim of the study is to explore and analyze the risk factors for VPI in mGGN type lung adenocarcinoma.
Methods: From November 2016 to November 2019, 128 patients with mGGN lung adenocarcinoma underwent radical surgical resection in the First Affiliated Hospital of Nanjing Medical University. Their clinical data, including imaging, pathological and biological features, were collected and analyzed retrospectively. There were 40 males and 88 females, aged 60.3±9.3 years ranging from 30 to 81 years. Single factor Chi-square test and multivariate Logistic regression were used to analyze the risk factors of VPI in mGGN type lung adenocarcinoma.
Results: Among 128 mGGN patients who met the inclusion criteria, 57 cases were pathologically confirmed with pleural invasion. Between the VPI (+) and VPI (-) group (P<0.05), there were significant differences in gender, maximum diameter of solid component, consolidation tumor ratio (CTR), spicule sign, history of lung disease, family history of hypertension, relation of lesion to pleura (RLP), coursing relationship between bronchi and nodules. In multivariate Logistic regression analysis, RLP (OR=3.529, 95%CI: 1.430-8.713, P=0.006) and coursing relationship between bronchi and nodules (OR=3.993, 95%CI: 1.517-10.51, P=0.005) were found to be independent risk factors for VPI (P<0.05).
Conclusions: The possibility of VPI in m GGN lung adenocarcinoma should be evaluated by combining these parameters in clinical diagnosis and treatment. As independent risk factors, RLP and coursing relationship between bronchi and nodules are instructive to identify VPI in mGGN type lung adenocarcinoma.
【中文题目：混合磨玻璃结节型肺腺癌脏层胸膜侵犯的 临床特征和危险因素分析】 【中文摘要：背景与目的 目前国内肺癌仍是发病率和致死率最高的恶性肿瘤，肺腺癌是其最常见的亚型，影像学中表现为混合性磨玻璃结节（mixed ground glass nodule, mGGN）的肺癌逐渐增多。脏层胸膜侵犯（visceral pleural invasion, VPI）是影响mGGN型肺腺癌预后的重要因素。本研究旨在探索分析mGGN型肺腺癌发生VPI的危险因素。方法 回顾性分析2016年11月-2019年11月南京医科大学第一附属医院收治的接受根治性手术的128例mGGN型肺腺癌患者的临床资料，包括影像、病理和生物学特征，其中男性40例、女性88例，年龄30岁-81（60.3±9.3）岁。采用单因素卡方检验与多因素Logistic回归分析调查mGGN型肺腺癌发生VPI的各项危险因素。结果 符合纳入标准的128例mGGN型肺腺癌患者中57例被诊断有VPI发生。性别、实性成分最大径、实性成分比例（consolidation tumor ratio, CTR）、毛刺征、肺部疾病史、高血压家族史、肿瘤-胸膜空间位置分型（relation of lesion to pleura, RLP）、支气管与结节走行关系在VPI（+）组和VPI（-）组间的差异均有统计学意义（P<0.05）。Logistic多因素回归分析发现RLP（OR=3.529, 95%CI: 1.430-8.713, P=0.006）和支气管与结节走行关系（OR=3.993, 95%CI: 1.517-10.51, P=0.005）是VPI发生的独立危险因素（P<0.05）。结论 临床诊治应综合上述参数评估mGGN型肺腺癌发生VPI的可能性。RLP和支气管与结节走行关系异常作为VPI的独立危险因素，对判断mGGN型肺腺癌发生VPI具有一定的指导意义。 】 【中文关键词：混合性磨玻璃结节；肺肿瘤；胸膜侵犯；计算机断层扫描】.
Keywords: Computed tomography; Lung neoplasms; Mixed ground glass nodule; Pleural invasion.