Clinical Characteristics and Risk Factors Analysis for Visceral Pleural Invasion in Mixed Ground-glass Nodular Lung Adenocarcinoma / 中国肺癌杂志

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.

The value of CT features in predicting visceral pleural invasion in clinical stage ⅠA peripheral lung adenocarcinoma under the pleura / 中华放射学杂志

Objective:To investigate the value of CT features in predicting visceral pleural invasion (VPI) in clinical stage ⅠA peripheral lung adenocarcinoma under the pleura.Methods:The CT signs of 274 patients with clinical stage ⅠA peripheral lung adenocarcinoma under the pleura diagnosed in Changzheng Hospital of Naval Medical University from January 2015 to November 2021 were retrospectively analyzed. According to the ratio of 6∶4, 164 patients collected from January 2015 to August 2019 were used as the training group, and 110 patients collected from August 2019 to November 2021 were used as the validation group. The maximum diameter of the tumor (T), the maximum diameter of the consolidation part (C), and the minimum distance between the lesion and the pleura (DLP) were quantitatively measured, and the proportion of the consolidation part was calculated (C/T ratio, CTR). The CT signs of the tumor were analyzed, such as the relationship between the tumor and the pleura classification, the presence of a bridge tag sign, the location of the lesion, density type, shape, margin, boundary and so on. Variables with significant difference in the univariate analysis were entered into multivariate logistic regression analysis to explore predictors for VPI, and a binary logistic regression model was established. The predictive performance of the model was analyzed by receiver operating characteristic curve in the training and validation group.Results:There were 121 cases with VPI and 153 cases without VPI among the 274 patients with lung adenocarcinoma. There were 79 cases with VPI and 85 cases without VPI in the training group. Univariate analysis found that the maximum diameter of the consolidation part, CTR, density type, spiculation sign, vascular cluster sign, relationship of tumor and pleura and bridge tag sign between patients with VPI and those without VPI were significantly different in the training group( P<0.05). Multivariate logistic regression analysis found the relationship between tumor and pleura [taking type Ⅰ as reference, type Ⅱ (OR=6.662, 95%CI 2.364-18.571, P<0.001), type Ⅲ (OR=34.488, 95%CI 8.923-133.294, P<0.001)] and vascular cluster sign (OR=4.257, 95%CI 1.334-13.581, P=0.014) were independent risk factors for VPI in the training group. The sensitivity, specifcity, and area under curve (AUC) for the logistic model in the training group were 62.03%, 89.41% and 0.826, respectively, using the optimal cutoff value of 0.504. The validation group obtained an sensitivity, specifcity, and AUC of 92.86%, 47.06%, and 0.713, respectively, using the optimal cutoff value of 0.449. Conclusion:The relationship between the tumor and the pleura and the vascular cluster sign in the CT features can help to predict visceral pleural invasion in the clinical stage ⅠA peripheral lung adenocarcinoma under the pleura.

Risk factors analysis for pleural invasion in small nodular typeⅠA lung adenocarcinoma / 中国胸心血管外科临床杂志

@#Objective    To explore and analyze the risk factors of pleural invasion in patients with small nodular type stage ⅠA pulmonary adenocarcinoma. Methods    From June 2016 to December 2017, 168 patients with small nodular type stage ⅠA pulmonary adenocarcinoma underwent surgical resection in the First Affiliated Hospital of Nanjing Medical University. There were 59 males and 109 females aged 58.7±11.5 years ranging from 28 to 83 years. The clinical data were analyzed retrospectively. Single factor Chi-square test and multivariate logistic regression were used to analyze the independent risk factors of pleural invasion. Results    Among 168 patients, 20 (11.9%) were pathologically confirmed with pleural invasion and 148 (88.1%) with no pleural invasion. Single factor analysis revealed significant differences (P<0.05) in nodule size, nodule status, pathological type, relation of lesion to pleura (RLP), distance of lesion to pleura (DLP), epidermal growth factor receptor (EGFR) mutation between patients with and without pleural invasion in stage ⅠA pulmonary adenocarcinoma. Logistic multivariate regression analysis showed that significant differences of nodule size, nodule status, RLP, DLP and EGFR mutation existed between the two groups (P<0.05), which were independent risk factors for pleural invasion. Conclusion    Imageological-pathological-biological characteristics of patients with small nodular type stage ⅠA pulmonary adenocarcinoma are closely related to pleural invasion. The possibility of pleural invasion should be evaluated by combining these parameters in clinical diagnosis and treatment.

Multivariate analysis of CT features of visceral pleural invasion of peripheral non-small cell lung cancer with the largest diameter less than or equal to 3 cm / 实用放射学杂志

Objective To analyze the CT features of visceral pleural invasion of peripheral non-small cell lung cancer with the largest diameter less than or equal to 3 cm to improve the diagnostic accuracy.Methods The CT features of 249 patients with peripheral non-small cell lung cancer with the largest diameter less than or equal to 3 cm were analyzed retrospectively.Multivariate Logistic regression was performed to analyze the independent risk factors of the visceral pleural invasion.Results Visceral pleural invasion was observed in 61/249 of the cases.Gender,the largest diameter,type,spiculated sign,lobulated sign,DLP and relationship of nodule and visceral pleura between the two groups were significantly different (P＜0.05).Multivariate Logistic regression analysis showed that the largest diameter and spiculated sign of nodules were independent risk factors for visceral pleural invasion.Visceral pleural invasion was uncommon in TypeⅠ.The probability of the visceral pleural invasion in typeⅡ,typeⅢand typeⅣ was 0.023 times (95% CI:0.006-0.093),0.225 times (95% CI:0.078-0.648)and 0.645 times (95% CI:0.261-2.300)as much as that of type Ⅴ,respectively.Visceral pleural invasion was more likely to occur in Type V than other types (P＜0.05).Conclusion The largest diameter and spiculated sign are independent predictors for visceral pleural invasion in non-small cell lung cancer with the largest diameter less than or equal to 3 cm.Nodules closely adjacent to the pleura are more likely to invade the visceral pleural.

Comparison of double staining of elastic fibers and broad-spectrum keratin with simple elastic fiber staining in cases of suspected pleural invasion of lung cancer / 临床与实验病理学杂志

Purpose To evaluate the effects of double stai-ning of elastic fibers and broad-spectrum keratin and simple e-lastic fiber staining in pleural invasion of lung cancer. Methods The pathological data of lung cancer from June 2015 to July 2016 in Jiangsu Province Hospital were retrospectively analyzed, of which 104 cases presented with suspected pleural invasion by HE staining. Double staining of elastic fibers and broad-spec- trum keratin and simple elastic fiber staining were adopted to compare their effects for pathological analysis on pleural invasion of lung cancer. Results 46 patients with positive pleural inva-sion were reported by simple elastic fiber staining, whereas 63 patients with positive pleural invasion were detected by double staining. The positive rate of double staining was 60. 58% , however the positive rate of simple elastic fiber staining was 44. 23% . The ability of double staining on detection of pleural invasion was significantly higher than simple elastic fiber stai-ning. Furthermore, following pathological analysis revealed that patients with contradictory results using double staining and sim-ple staining were mostly diagnosed by presence of single or sever-al broad-spectrum keratin-positive tumor cells which invaded the pleura. Conclusion Compared with simple elastic fiber stai-ning, double staining of elastic fibers and broad-spectrum keratin combines the advantages of these two methods, which can simul- taneously visualize the pleural and tumor cells, so as to better observe the adjacent relationship between tumor cells and sur-rounding pleura. Double staining of elastic fibers and broad-spectrum keratin is an efficient method for pathological diagnosis and benefit to following clinical treatment of patients with positive pleural invasion of lung cancer.

The HRCT findings of pleural invasion of lung adenocarcinoma presenting as mGGN / 实用放射学杂志

Objective To investigate the high resolution CT (HRCT) findings of pleura invasion of lung adenocarcinoma (stageⅠ) presenting as mixture ground glass nodule (mGGN).Methods 20 cases of lung adenocarcinoma presenting as mGGN were confirmed by pathology.The correlation of those cases with pleural adjacent relation and the relation between the maximum diameter and pleural invasion were analyzed retrospectively.Results (1)The classification of mGGN adjacent to the pleura relationship:type Ⅰ,typical and atypical pleural retraction sign,10 cases of this type did not show pleural invasion;type Ⅱa,the mGGN contacted pleural for ground glass opacity,4 cases of this type showed no pleural invasion;type Ⅱb,the mGGN contacted pleural for solid elements,6 cases of this type were with pleural invasion.(2)The difference of the maximum diameter of mGGN in groups pleural invasion and non-invasion was not significant statistically (P=0.694).Conclusion The mGGN contacted pleural for solid composition is a reliable sign in diagnosis of pleural invasion.

Impact of visceral pleural invasion and vessel invasion on initial recurrence site and prognosis in surgically resected non-small cell lung cancer / 中国癌症杂志

Background and purpose:Visceral pleural invasion (VPI) and vessel invasion (VI) are poor prognostic factors in patients with non-small cell lung cancer (NSCLC). The primary initial recurrence site may be local recurrence in VPI and distant metastasis in VI. The purpose of this study was to validate the prognostic impact and effect of the initial recurrence site of VPI and VI on survival outcomes for NSCLC.Methods:Two hundred and ninety patients who were diagnosed as having NSCLC and underwent lobectomy between Jan. 2007 and Dec. 2013 were retrospectively analyzed. VPI was identiifed in 51 patients as VPI group, the other 239 patients without VPI as non-VPI group. VI was identiifed in 29 patients as VI group, the other 261 patients without VI as non-VI group. Clinical characteristics, overall survival (OS), disease-free survival (DFS) were compared.Results:There were statistically signiifcant differences between VPI group and non-VPI group in tumor size, lymph node metastasis, TNM stage and initial recurrence site (P 72.3%,P=0.001). Cox regression showed TNM stage was a significant prognostic factor for DFS, whereas lymph node metastasis and VPI were signiifcant prognostic factors in patients with NSCLC.Conclusion:The primary initial recurrence site in VPI patients is local recurrence. Patients with VPI or VI may need more postoperative therapy because of their poor prognosis.

Visceral Pleural Invasion as a Prognostic Factor for Recurrence in Resected IB Non-small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: Several trials have reported on whether adjuvant chemotherapy for resected stage IB non-small cell lung cancer is needed. The aim of our study was to investigate prognostic factors for recurrence to help identify patients who should receive adjuvant chemotherapy. MATERIAL AND METHOD: We reviewed the cases of 48 stage IB non-small cell lung cancer patients between 1997 and 2006. Disease-free survival and overall survival rates were calculated by the Kaplan-Meier method. Univariate analysis was performed with the log rank test and multivariate analysis was done using Cox's proportional hazard model. RESULT: The median follow-up time was 48 months. The overall survival rate was 55.9%, and the disease-free survival rate was 48.6%. Of 8 variables, two factors, visceral pleural invasion and lymphovascular invasion, were prognostic factors of disease-free survival (univariate analysis). Visceral pleural invasion was a significant prognostic factor in multivariate analysis, and overall survival in compared one or more variable such as visceral pleural invasion or, and lymphovascular invasion with the other variables. CONCLUSION: Visceral pleural invasion was identified as a poor prognostic factor and it may help select which patients will benefit from adjuvant chemotherapy in addition to more comprehensive follow-up.