Clinical characteristics on low-dose high-resolution computed tomography and serum tumor markers of malignant...

To observe the clinical features of low-dose, high-resolution computed tomography (LDCT) and changes in serum tumor markers in malignant pulmonary solid small nodules (MPSSN), and to analyze the difference in survival of patients with malignant and benign PSSN 3 years after surgery.

Patients were enrolled from the thoracic surgery department of three hospitals. According to pathological diagnosis, all patients were divided into the case group (MPSSN, n=157) and the control group (BPSSN, n=75). There were no significant differences in gender, smoking habit, and family disease history. All subjects were subjected to LDCT. Four serum tumor markers (CEA, SCC, NSE, ProGRP) were examined simultaneously. Two independent sample t-tests, Mann-Whitney U rank sum test and Pearson chi-square test were used for comparsions. Two-category logistic regression was performed to analyze LDCT index and serum tumor markers levels of the two groups. ROC curve was used to evaluate the diagnostic sensitivity and specificity of relevant indicators. Kaplan-Meier method, log-rank and generalized Wilcoxon test were used to analyze the survival rate of patients after surgery.

In univariate analysis, age, nodule size, bronchial aeration sign, bronchial truncation sign, burr sign, smooth sign and lobulated sign, SCC, NSE, and ProGRP were significantly different between two groups (p<0.05 or 0.01). In the regression analysis, there was a significant correlation between MPSSN and age (X1) [95%CI (1.272, 5.257), p=0.009], nodule size (X2) [95%CI (1.066, 2.746), p=0.041], bronchial aeration sign (X3) [95%CI (1.384, 11.425), p=0.010], bronchial truncation sign (X4) [95 %CI (1.269, 13.444), p=0.018] and burr sign (X5) [95%CI (0.054, 0.661), p=0.009], ProGRP (X10) [95%CI (1.302, 2.439), p=0.040]. The stepwise regression equation is Logistic(p)=-3.014+0.950 X1+0.064 X2+1.380 X3+1.419 X4-1.666 X5+0.263 X10. Log-rank and generalized Wilcoxon test analysis showed no difference in survival rate between the two groups (log rank p=0.271, generalized Wilcoxon, p=0.139).

The levels of CEA, SCC, NSE and ProGRP in MPSSN were increased; age, nodule size, bronchial aeration sign, bronchial truncation sign and burr sign had predictive value for MPSSN. Patients with PSSN had better survival rates at 3 years after surgery.