Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China.
BMC Pulm Med. 2023 Oct 7;23(1):377. doi: 10.1186/s12890-023-02690-3.
The new grading system for invasive nonmucinous lung adenocarcinoma (LUAD) in the 2021 World Health Organization Classification of Thoracic Tumors was based on a combination of histologically predominant subtypes and high-grade components. In this study, a model for the pretreatment prediction of grade 3 tumors was established according to new grading standards.
We retrospectively collected 399 cases of clinical stage I (cStage-I) LUAD surgically treated in Tianjin Chest Hospital from 2015 to 2018 as the training cohort. Besides, the validation cohort consists of 216 patients who were collected from 2019 to 2020. These patients were also diagnosed with clinical cStage-I LUAD and underwent surgical treatment at Tianjin Chest Hospital. Univariable and multivariable logistic regression analyses were used to select independent risk factors for grade 3 adenocarcinomas in the training cohort. The nomogram prediction model of grade 3 tumors was established by R software.
In the training cohort, there were 155 grade 3 tumors (38.85%), the recurrence-free survival of which in the lobectomy subgroup was better than that in the sublobectomy subgroup (P = 0.034). After univariable and multivariable analysis, four predictors including consolidation-to-tumor ratio, CEA level, lobulation, and smoking history were incorporated into the model. A nomogram was established and internally validated by bootstrapping. The Hosmer-Lemeshow test result was χ = 7.052 (P = 0.531). The C-index and area under the receiver operating characteristic curve were 0.708 (95% CI: 0.6563-0.7586) for the training cohort and 0.713 (95% CI: 0.6426-0.7839) for the external validation cohort.
The nomogram prediction model of grade 3 LUAD was well fitted and can be used to assist in surgical or adjuvant treatment decision-making.
2021 年世界卫生组织胸部肿瘤分类中，浸润性非黏液性肺腺癌（LUAD）采用了新的分级系统，该系统基于组织学主要亚型和高级别成分的组合。本研究根据新的分级标准，建立了预测术前 3 级肿瘤的模型。
回顾性收集 2015 年至 2018 年在天津胸科医院接受手术治疗的临床Ⅰ期（cStage-I）LUAD 患者 399 例作为训练队列，验证队列由 2019 年至 2020 年在天津胸科医院接受手术治疗的 216 例临床 cStage-I LUAD 患者组成。采用单变量和多变量逻辑回归分析筛选训练队列中 3 级腺癌的独立危险因素。R 软件建立了 3 级肿瘤的列线图预测模型。
在训练队列中，有 155 例 3 级肿瘤（38.85%），其中肺叶切除术亚组的无复发生存率优于肺段切除术亚组（P=0.034）。单变量和多变量分析后，将包括实变与肿瘤比值、CEA 水平、分叶征和吸烟史的 4 个预测因素纳入模型。建立了列线图并通过 bootstrap 进行内部验证。Hosmer-Lemeshow 检验结果为 χ²=7.052（P=0.531）。训练队列的 C 指数和接受者操作特征曲线下面积分别为 0.708（95%CI：0.6563-0.7586），外部验证队列分别为 0.713（95%CI：0.6426-0.7839）。
预测 3 级 LUAD 的列线图预测模型拟合良好，可用于辅助手术或辅助治疗决策。
