Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study.
Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study.
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DOI：
10.18632/oncotarget.11236
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发表时间：
2017-03-07
期刊：
影响因子：
--
通讯作者：
Chen C
中科院分区：
文献类型：
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作者：
She Y;Zhao L;Dai C;Ren Y;Zha J;Xie H;Jiang S;Shi J;Shi S;Shi W;Yu B;Jiang G;Fei K;Chen Y;Chen C
建立术前形态图，以区分侵袭性肺腺癌（IPAs）与侵袭前病变的孤立性纯磨玻璃结节（GGN）。回顾性研究了2009年1月至2015年9月5所医院病理证实的肺孤立性纯GGN术后患者的主要队列。一半的患者被随机选择并分配到模型开发队列，其余患者被分配到验证队列。基于独立危险因素构建预测孤立性ggn侵袭程度的nomogram。采用一致性指数（C-index）和校准曲线评价预测效果。在纳入研究的898例病例中，501例（55.8%）为侵袭前病变，397例（44.2%）为IPAs。在单因素分析中，病变大小（p < 0.001）、病变边缘（p = 0.041）、病变形状（p < 0.001）、平均CT值（p = 0.018）、胸膜压痕（p = 0.017）和吸烟状况（p = 0.014）与侵袭程度显著相关。在多因素分析中，病变大小（p < 0.001）、病变边缘（p = 0.042）、病变形状（p < 0.001）、平均CT值（p = 0.014）、胸膜压痕（p = 0.026）、吸烟状况（p = 0.004）仍是影响肿瘤侵袭程度的预测因素。建立了nomogram，验证结果显示C-index为0.94，表明预测结果与观测结果具有良好的一致性。我们建立并验证了一种新的nomogram，可以从孤立性纯GGN患者的侵袭前病变中识别IPAs。
To construct a preoperative nomogram to differentiate invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions in patients with solitary pure ground-glass nodules (GGN). A primary cohort of patients with pathologically confirmed pulmonary solitary pure GGN after surgery were retrospectively studied at five institutions from January 2009 to September 2015. Half of the patients were randomly selected and assigned to a model-development cohort, and the remaining patients were assigned to a validation cohort. A nomogram predicting the invasive extent of the solitary GGNs was constructed based on the independent risk factors. Predictive performance was evaluated by concordance index (C-index) and calibration curve. Out of 898 cases included in the study, 501 (55.8%) were preinvasive lesions and 397 (44.2%) were IPAs. In the univariate analysis, lesion size (p < 0.001), lesion margin (p = 0.041), lesion shape (p < 0.001), mean computed tomography (CT) value (p = 0.018), presence of pleural indentation (p = 0.017), and smoking status (p = 0.014) were significantly associated with invasive extent. In multivariate analysis, lesion size (p < 0.001), lesion margin (p = 0.042), lesion shape (p < 0.001), mean CT value (p = 0.014), presence of pleural indentation (p = 0.026), and smoking status (p = 0.004) remained the predictive factors of invasive extent. A nomogram was developed and validation results showed a C-index of 0.94, demonstrating excellent concordance between predicted and observed results. We established and validated a novel nomogram that can identify IPAs from preinvasive lesions in patients with solitary pure GGN.