独立队列中偶然发现的小纯磨玻璃结节的生长模式与风险分层
Growth Patterns and Risk Stratification of Incidental Small Pure Ground-Glass Nodules across Independent Cohorts.
作者
作者单位
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen St, Linhai 317000, Zhejiang Province, China.
- Dalian Medical University, Dalian, China.
- Department of Thoracic Surgery, Enze Hospital, Taizhou Enze Medical Center, Linhai, China.
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Cardiothoracic Surgery, Jingjiang People's Hospital Affiliated to Yangzhou Medical University, Jingjiang, China.
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital, Jiaxing University, Jiaxing, China.
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China.
- Northern General Hospital, Sheffield, UK.
摘要
中文
背景 低剂量CT的广泛应用增加了小纯磨玻璃结节（pGGNs）的检出。目前这类结节的管理仍是一个临床挑战。目的 描述偶发性小pGGNs的长期生长轨迹，确定结节生长和进展的危险因素，并评估这些发现在独立队列中的可重复性。材料与方法 本回顾性研究纳入2017年6月至2019年6月在温州医科大学附属浙江省台州医院（中心1）和温州医科大学附属第一医院（中心2）常规健康体检中低剂量胸部CT检测到的偶发性小pGGNs（<10 mm）患者。所有患者均接受每年一次CT随访，持续5年。为调整患者内聚类，所有结节水平和危险因素分析均采用以个体患者为随机效应的混合效应模型。使用潜在类别轨迹模型识别生长模式，并通过多变量混合效应Logistic回归评估独立危险因素。结果 本研究纳入910例患者（中位年龄47岁[IQR，41-57岁]；男性422例，女性488例；1206个pGGNs）。在中心1（n=754个pGGNs），8.6%（65/754）的结节表现出生长，泡状透亮影（风险比=2.39；P=0.02）、血管征（风险比=2.98；P=0.006）和肺癌家族史（风险比=2.83；P=0.02）是与结节生长相关的独立危险因素。在中心2（n=452个pGGNs），血管征（风险比=2.98；P=0.04）和家族史（风险比=3.94；P=0.01）与结节生长相关。潜在类别轨迹模型在两个中心的患者中识别出一种独特的进行性生长模式，在该模式中，肺癌家族史在中心1（比值比=4.23；P=0.01）和中心2（比值比=5.01；P=0.003）均为独立危险因素，血管征是中心2的另一危险因素（比值比=4.38；P=0.01）。结论 在两个独立临床队列中，低剂量胸部CT检测到的偶发性pGGNs患者中识别出一种与肺癌家族史相关的独特进行性生长模式。© 作者2026年。由北美放射学会根据CC BY 4.0许可发布。本文提供补充材料。另见本期Lee和Um的社论。
English
Background The widespread adoption of low-dose CT has increased the detection of small pure ground-glass nodules (pGGNs). The management of this type of nodule currently remains a clinical challenge. Purpose To characterize long-term growth trajectories of incidental small pGGNs, identify risk factors for nodule growth and progression, and assess the reproducibility of these findings in an independent cohort. Materials and Methods This retrospective study included patients with incidental small pGGNs (<10 mm) detected with low-dose chest CT during routine wellness assessments at Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University (center 1) and the First Affiliated Hospital of Wenzhou Medical University (center 2) from June 2017 to June 2019. All patients underwent annual CT follow-up for 5 years. To adjust for intrapatient clustering, all nodule-level and risk factor analyses used mixed-effects models with the individual patient as a random effect. Latent class trajectory modeling was used to identify growth patterns, with independent risk factors evaluated via multivariable mixed-effects logistic regression. Results This study included 910 patients (median age, 47 years [IQR, 41-57 years]; 422 men, 488 women; 1206 pGGNs). At center 1 (n = 754 pGGNs), 8.6% (65 of 754) of nodules exhibited growth, and bubble lucency (hazard ratio = 2.39; P = .02), vessel sign (hazard ratio = 2.98; P = .006), and family history of lung cancer (hazard ratio = 2.83; P = .02) were independent risk factors associated with nodule growth. At center 2 (n = 452 pGGNs), vessel sign (hazard ratio = 2.98; P = .04) and family history (hazard ratio = 3.94; P = .01) were associated with nodule growth. Latent class trajectory modeling identified a distinct progressive growth pattern in patients from both centers, for which family history of lung cancer was an independent risk factor at center 1 (odds ratio = 4.23; P = .01) and center 2 (odds ratio = 5.01; P =.003), with vessel sign being another risk factor at center 2 (odds ratio = 4.38; P = .01). Conclusion Across two independent clinical cohorts, a distinct progressive growth pattern associated with family history of lung cancer was identified in patients with incidental pGGNs detected at low-dose chest CT. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Lee and Um in this issue.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 17.6
- 新锐分区
- 1区