Journal of Peking University(Health Sciences) ›› 2020, Vol. 52 ›› Issue (1): 158-162. doi: 10.19723/j.issn.1671-167X.2020.01.025

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Prognosis factors analysis of patients with malignant solitary pulmonary nodules

Yu-qing OUYANG,Lian-fang NI,Xin-min LIU()   

  1. Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
  • Received:2017-11-13 Online:2020-02-18 Published:2020-02-20
  • Contact: Xin-min LIU E-mail:lxm2128@163.com

Abstract:

Objective: To explore the prognosis factors that influence the postoperative survival rate in patients with malignant solitary pulmonary nodules and to provide a reference for the prognosis risk stratification of early lung cancer patients. Methods: In this study, we retrospectively reviewed 172 patients who were admitted to Peking University First Hospital from April 2006 to December 2013. All cases were radiologically defined as solitary pulmonary nodule and were pathologically confirmed to be stage Ⅰa non-small cell lung cancer after surgical procedure. The patients’ clinical and follow-up data were summarized and analyzed. The relevance between survival time and factors that may affect patients’ prognosis was evaluated, which included gender, age, clinical symptoms, smoking history, comorbidity index, tumor biomarkers, nodule type, type of surgery, nodule location, nodule histopathological type, nodule size, histopathological differentiation grade, proliferating cell nuclear antigen Ki-67 expression level and epidermal growth factor receptor (EGFR) gene mutation. Kaplan-Meier survival analysis, Cox univariant and multivariant regression analysis were conducted to evaluate the factors affecting prognosis. Results: The 3-year overall survival rate of the atients with malignant solitary pulmonary nodules was 93.6%, and the 5-year overall survival rate was 89.8%. Kaplan-Meier survival analysis and Cox univariant regression analysis showed that the overall survival rate of the male patients was significantly lower than that of the female patients. In addition, the elderly patients with histopathology characterized as high Ki-67 proliferation index were also associated with the worse overall survival (P<0.05). Cox multivariant regression analysis demonstrated that age more than 65 years as well as the high Ki-67 expression level were independent risk factors for overall survival in patients with malignant solitary pulmonary nodules (age: P=0.023, HR=3.531, 95%CI 1.190-10.472; Ki-67: P=0.004, HR=1.021, 95%CI 1.007-1.035). Conclusion: For patients with malignant solitary pulmonary nodules, with pathological defined as stage Ⅰa non-small cell lung cancer, age, gender and Ki-67 expression levels might be important prognostic factors. Comprehensive consideration of Ki-67 proliferation index and clinical pathological features may help to stratify the prognosis more accurately and guide the selection of appropriate therapeutic strategies, which needs to be verified by multi-center studies.

Key words: Malignant solitary pulmonary nodule, Stage Ⅰa non-small cell lung cancer, Prognosis factor

CLC Number: 

  • R734.2

Table 1

Patient demographic data"

Variables Numbers
Gender
Male 88 (51.2%)
Female 84 (48.8%)
Age/years
<65 100 (58.1%)
≥65 72 (41.9%)
Symptom
Negtive 109 (63.4%)
Positive 63 (36.6%)
CCI
0 113 (65.7%)
≥1 59 (34.3%)
Smoking
No 117 (68.0%)
Yes 55 (32.0%)
Tumor markers
Normal 80 (55.9%)
Elevated 63 (44.1%)
Nodule type
GGO 34 (31.8%)
SSN/SN 73 (68.2%)
Surgical methods
Lobectomy 165 (95.9%)
Segmentectomy 7 (4.1%)
Surgical typs
Thoracotomy 129 (75.3%)
VATS 43 (24.7%)
Nodule location
Upper lobe 65 (37.8%)
Middle/lower lobe 107 (62.2%)
Nodule size
≤2 cm 102 (59.3%)
>2 cm 70 (40.7%)
Histological type
Adenocarcinoma 124 (71.1%)
Other 48 (28.9%)
Differentiation grade
Poor 24 (14.0%)
Moderate/well 148 (86.0%)
EGFR mutation
Negative 41 (65.1%)
Positive 22 (34.9%)

Figure 1

Kaplan-Meier survival curves of patients with malignant SPN"

Figure 2

Kaplan-Meier survival curves of patients with malignant SPN stratified by gender"

Figure 3

Kaplan-Meier survival curves of patients with malignant SPN stratified by age"

Table 2

Survival analysis and univariant analysis of malignant SPN patients overall survival"

Items 3-year survival 5-year survival HR(95%CI) P
Gender Male 90.9 84.1 0.302 (0.113-0.816) 0.018
Female 96.4 96.4
Age/years <65 97.0 92.8 2.634 (1.124-6.176) 0.026
≥65 88.9 85.5
Symptom Negative 95.4 89.5 1.014 (0.433-2.376) 0.974
Positive 90.5 90.5
CCI 0 93.8 91.3 1.342 (0.584-3.082) 0.488
≥1 93.2 86.7
Smoking No 94.9 91.0 1.794 (0.800-4.021) 0.156
Yes 90.9 87.0
Tumor markers Normal 98.8 95.6 1.623 (0.587-4.488) 0.350
Elevated 92.1 85.4
Nodule type GGO 100.0 100.0 34.859 (0.071-17 033.177) 0.261
SSN/SN 94.5 91.3
Surgery type Thoracotomu 96.1 91.9 1.627 (0.695-3.808) 0.262
VATS 86.0 83.7
Nodule location Upper lobe 93.8 91.7 1.092 (0.719-1.657) 0.681
Middle/lower lobe 93.3 88.2
Nodule size ≤2 cm 97.1 94.1 1.861 (0.824-4.204) 0.135
>2 cm 88.6 83.5
Histological type Adenocarcinoma 94.4 89.9 0.953 (0.402-2.260) 0.913
Other 91.7 89.2
Differentiation grade Poorly 79.2 73.9 0.434 (0.178-1.054) 0.065
Moderate/well 95.9 92.4
Ki-67 - - - 1.019 (1.005-1.033) 0.008
EGFR mutation Negative 92.7 92.7 0.609 (0.063-5.856) 0.668
Positve 95.5 95.5

Table 3

Multivariant analysis of malignant solitary pulmonary nodules patients overall survival"

Variables B SE Wald HR P
Age 1.261 0.555 5.171 3.531 (1.190-10.472) 0.023
Ki-67 0.021 0.007 8.384 1.021 (1.007-1.035) 0.004
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