Clinical and imaging risk factors analysis of postoperative pathological upgrading to invasive cancer in early lung adenocarcinoma patients

To explore the clinical and imaging risk factors for postoperative pathological upgrading of early lung adenocarcinoma to invasive cancer. In this retrospective study, 312 patients with surgically treated early-stage lung adenocarcinoma (Jan 2023‑Dec 2025) were stratified into non-infiltration and infiltration groups based on postoperative paraffin pathology. Clinical and imaging data were compared between the two groups. Univariate and multivariate logistic regression analyses were used to screen independent risk factors for postoperative pathological upgrading, and ROC curve analysis was used to evaluate predictive performance. Among 312 patients with early lung adenocarcinoma, 89 (28.52%) were in the infiltration group and 223 (71.48%) were in the non-infiltration group. The age, tumor diameter, and stage IIIa of the tumor in the infiltration group were higher than those in the non-infiltration group, and the hemoglobin level was lower than that in the control group ( P < 0.05). The proportion of patients with vascular bundle, air bronchial, and vacuolar signs in the infiltration group was higher than that in the non-infiltration group ( P < 0.05). Multivariate logistic regression analysis found that age, tumor diameter, tumor stage, hemoglobin, and vascular bundle sign were the influencing factors for the pathological upgrade of early lung adenocarcinoma to invasive cancer after surgery ( P < 0.05). A binary logistic regression model was used to construct the joint prediction probability of postoperative pathological upgrade and invasive cancer in early lung adenocarcinoma. ROC analysis was performed on the model output probability value. The results showed that the AUC of age, tumor diameter, tumor stage, hemoglobin, and vascular bundle sign combined detection of postoperative pathological upgrade and invasive cancer in early lung adenocarcinoma was higher than that of single detection ( P < 0.05). Age, tumor diameter, tumor stage, hemoglobin level, and the presence of a vascular bundle sign on imaging are key factors influencing the postoperative pathological upgrading of early lung adenocarcinoma to invasive cancer. Combined detection can improve the evaluation efficiency of postoperative pathological upgrading in patients with early lung adenocarcinoma. This risk model can provide an auxiliary preoperative risk stratification reference for clinicians but cannot replace a comprehensive clinical-radiological multidisciplinary assessment.