肺腺癌与鳞癌微观延展对GTV→CTV的影响  

Influence of microextension on clinical target volume delineation in adenocarcinoma and squamous cell carcinoma among patients with non-small cell lung cancer

作　　者：张伟克[1] 解丽梅[1] 王忠山[1] 庞得全[1] 

机构地区：[1]泰山医学院附属莱钢医院肿瘤科,莱芜271100

出　　处：《中华放射肿瘤学杂志》2017年第5期522-526,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 更好了解不同类型NSCLC肿瘤最大径与最远微转移之间关系,提供由GTV确定CTV外扩范围更精确的组织学依据.方法 对2014-2015年间收治的113例NSCLC （44例鳞癌、69例腺癌）术后病理标本进行回顾分析.肿瘤最大直径由大体测量与显微镜下测量结合确定,肿瘤微观转移灶由显微镜下观察确定,肿瘤边界外局部微观转移灶与肿瘤之间距离以目镜测微尺测量计算得出.定量资料采用t检验,定性资料采用Logistic方法回归分析.结果 腺癌组肿瘤最大径与微观转移回归关系显著,鳞癌组未见相关性（P=0.151）.腺癌组淋巴结转移阳性与否与最远微观转移两者关系显著,鳞癌组未见相关性（P=0.597）.肿瘤分化程度无论与腺癌还是鳞癌的最远微观转移均未见相关性（P=0.113）.腺癌组平均最远微观转移距离为2.94 mm,覆盖95%的最远微观转移距离为7.5 mm.肿瘤最大径〈3 cm腺癌覆盖95%的最远微观转移需要4 mm,3~5 cm需要6 mm,〉5 cm需要7.5 mm;鳞癌组平均最远微观转移距离2.69 mm,覆盖95%的最远微观转移距离为6 mm.结论 肺腺癌的微观转移最远距离与肿瘤最大径和有无淋巴结转移相关,靶区勾画时GTV到CTV外扩范围应据此调整;鳞癌微观转移最远距离与肿瘤最大径未见相关性;腺癌与鳞癌的微观转移最远距离与肿瘤分化程度均无相关性.Objective To better understand the relationship between the maximum tumor diameter and the most distant micrometastases in different types of non-small cell lung cancer （NSCLC） and to provide histological evidence for the delineation of clinical target volume （CTV） from gross tumor volume.Methods We retrospectively studied the pathological specimens from 113 surgically treated NSCLC patients （44 squamous cell carcinoma patients and 69 adenocarcinoma patients） who were admitted to our hospital from 2014 to 2015.The maximum tumor diameter was determined by a combination of gross and microscopic measurements.Micrometastases were microscopically determined.The distances between the tumor edges and micrometastases outside the tumor boundaries were measured by an ocular micrometer followed by a calculation.Quantitative data were analyzed by t test, and qualitative data were analyzed by logistic regression.Results The regression relationship between the maximum tumor diameter and micrometastases was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group （P=0.151）.The association between the presence or absence of lymph node metastasis and the most distant micrometastasis was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group （P=0.597）.No association between the degree of tumor differentiation and the most distant micrometastasis was observed in either group （P=0.113）.The average measurement of the most distant micrometastases was 2.94 mm in the adenocarcinoma group, with 7.5 mm as the distance to cover 95% of the most distant micrometastases.To reach the same coverage, 4 mm was needed for tumor size smaller than 3 cm, 6 mm for those between 3 cm and 5 cm, and 7.5 mm for those larger than 5 cm.The average measurement of the most distant micrometastases was 2.69 mm in the squamous cell carcinoma group, with 6 mm as the distance to cover 95% of the most distant micrometastases.Conclusions For NSCLC, the most di

关 键 词：肺肿瘤/外科学 微观延展/病理学 临床靶体积 肺肿瘤/三维适形放射疗法 

分 类 号：R730.55[医药卫生—肿瘤] R734.2[医药卫生—临床医学]