Wu Quanyang, Zhao Shijun, Huang Yao, Wang Jianwei, Tang Wei, Zhou Lina, Qi Linlin, Zhang Zewei, Xie Yuting, Zhang Jiaxing, Li Hongjia, Wu Ning
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2023 Jan 4;12:1061242. doi: 10.3389/fonc.2022.1061242. eCollection 2022.
Screening for lung cancer with LDCT detects a large number of nodules. However, it is unclear whether nodule number influences lung cancer probability. This study aimed to acquire deeply insight into the distribution characteristics of nodule number in the Chinese population and to reveal the association between the nodule number and the probability of lung cancer (LC).
10,167 asymptomatic participants who underwent LDCT LC screening were collected. Noncalcified nodules larger than 4 mm were included. The nodule number per participant was determined. We defined five categories according to the number of nodules (based on nodule type and size): one, two, three, four, and more than four nodules. We stratified the nodules as groups A, B, and C and participants as Amax, Bmax, and Cmax groups, and explored the association between nodule number and the probability of LC on nodule and participant levels.
97 participants were confirmed to have LC. The probabilities of LC were 49/1719, 22/689, 11/327, 6/166, and 9/175 in participants with one, two, three, four, and more than four nodules (p>0.05), respectively. In the Bmax group, the probability of LC was significantly higher in participants with one nodule than those with >4 nodules (p<0.05), and the probability of LC showed a negative linear trend with increasing nodule numbers (p<0.05). Based on the nodule-level analyses, in Group B, LC probability was significantly higher when participants had a solitary nodule than when they had >4 nodules (p<0.05).
LC probability does not significantly change with the number of nodules. However, when stratified by the nodule size, the effect of nodule number on LC probability was nodule-size dependent, and greater attention and active follow-up are required for solitary nodules especially SNs/solid component of PSNs measuring 6-15 mm or NSNs measuring 8-15 mm. Assessing the nodule number in conjunction with nodule size in baseline LDCT LC screening is considered beneficial.
低剂量计算机断层扫描（LDCT）筛查肺癌可检测出大量结节。然而，尚不清楚结节数量是否会影响患肺癌的概率。本研究旨在深入了解中国人群中结节数量的分布特征，并揭示结节数量与肺癌（LC）概率之间的关联。
收集了10167名接受LDCT肺癌筛查的无症状参与者。纳入直径大于4mm的非钙化结节。确定每位参与者的结节数量。我们根据结节数量（基于结节类型和大小）将其分为五类：一个、两个、三个、四个以及超过四个结节。我们将结节分为A、B、C组，将参与者分为Amax、Bmax和Cmax组，并在结节和参与者层面探讨结节数量与肺癌概率之间的关联。
97名参与者被确诊患有肺癌。有一个、两个、三个、四个以及超过四个结节的参与者患肺癌的概率分别为49/1719、22/689、11/327、6/166和9/175（p>0.05）。在Bmax组中，有一个结节的参与者患肺癌的概率显著高于有超过4个结节的参与者（p<0.05），且患肺癌的概率随结节数量增加呈负线性趋势（p<0.05）。基于结节层面的分析，在B组中，参与者有单个结节时患肺癌的概率显著高于有超过4个结节时（p<0.05）。
肺癌概率不会随结节数量显著变化。然而，按结节大小分层时，结节数量对肺癌概率的影响取决于结节大小，对于单个结节尤其是直径6 - 15mm的实性结节/部分实性结节或直径8 - 15mm的非实性结节，需要给予更多关注并积极随访。在基线LDCT肺癌筛查中结合结节大小评估结节数量被认为是有益的。
