Clinical symptoms and prognosis of patients with pulmonary nodules: a real-world cohort study.

OBJECTIVE: To identify risk factors for pulmonary nodule progression based on a prospective cohort of 392 patients. METHODS: Baseline clinical, imaging and quantitative indicators including volume doubling time (VDT) and fatigue scores were compared between patients with stable and progressive nodules. Univariate and multivariate Cox regression models were used to analyze prognostic factors. RESULTS: Among all subjects, 61.0% had COVID-19 infection history, and 33.7% of nodules presented lobulation and spiculation. During follow-up, 25.2% of nodules progressed, and the progression group had shorter VDT and higher fatigue scores (P < 0.05). Nevertheless, CIS-Fatigue could not predict the progression of pulmonary nodules. Multivariate Cox regression demonstrated that age, smoking history and irregular nodule margins were independent risk factors. Each 5-year age increase and smoking history raised progression risk by 1.2-fold. Nodules with spiculated and lobulated margins had a 1.5-fold higher growth risk, while COVID-19 infection was not an independent predictor. CONCLUSION: Age, smoking status and high-risk imaging features predict nodule progression. Risk-stratified follow-up should be performed for high-risk populations.