多因素分析最大径≤3cm周围型非小细胞肺癌脏层胸膜侵犯的CT特征  

Multivariate analysis of CT features of visceral pleural invasion of peripheral non-small cell lung cancer with the largest diameter less than or equal to 3 cm

作　　者：彭兆辉 范丽[1] 王祥[1] 刘士远 PENG Zhaohui;FAN Li;WANG Xiang;LIU Shiyuan(Department of Radiology, Changzheng Hospital,the Second Military Medical University,Shanghai 200003,China;Department of Radiology ,General Hospital of Ji ＇nan Military Command ,Ji ＇nan 250031,China)

机构地区：[1]第二军医大学长征医院影像科,上海200003 [2]济南军区总医院医学影像科,山东济南250031

出　　处：《实用放射学杂志》2018年第6期850-853,868,共5页Journal of Practical Radiology

基　　金：国家重点研发计划项目（2016YFE0103000）;上海生物医药重大专项项目（13411950100）;国家自然科学基金项目（81370035,81230030）;上海市浦江人才计划项目（15PJD002）.

摘　　要：目的 分析最大径≤3 cm周围型非小细胞肺癌脏层胸膜侵犯的CT特征，提高脏层胸膜侵犯诊断的准确度。方法 回顾性分析249例最大径≤3 cm周围型非小细胞肺癌患者的CT特征，利用多因素Logistic回归分析出与脏层胸膜侵犯相关的独立危险因素。结果 249例结节中脏层胸膜侵犯61例，无脏层胸膜侵犯188例。性别、最大径、类型、毛刺征、分叶征、结节至胸膜的最短距离（DLP）、结节与脏层胸膜的关系在2组间差异有统计学意义（P值均＜0.05）。多因素Logistic回归分析结果发现结节最大径、毛刺征是脏层胸膜侵犯的独立危险因素。Ⅰ型不容易发生脏层胸膜侵犯，Ⅱ型发生脏层胸膜侵犯的概率是Ⅴ型的0.023倍（95% CI：0.006～0.093），Ⅲ型发生脏层胸膜侵犯的概率是Ⅴ型的0.225倍（95% CI：0.078～0.648），Ⅳ型发生脏层胸膜侵犯的概率是Ⅴ型的0.645倍（95% CI：0.261～2.300），Ⅴ型较其他类型更容易发生脏层胸膜侵犯（P＜0.05）。结论 最大径≤3 cm周围型非小细胞肺癌脏层胸膜侵犯的CT特征中最大径、毛刺征是脏层胸膜侵犯的独立危险因素，与胸膜紧密相贴的肺癌更容易发生脏层胸膜侵犯。Objective To analyze the CT features of visceral pleural invasion of peripheral nowsmall cell lung cancer with the largest diameter less than or equal to 3 cm to improve the diagnostic accuracy.Methods The CT features of 249 patients with peripheral non small cell lung cancer with the largest diameter less than or equal to 3 cm were analyzed retrospectively. Multivariate Logistic regression was performed to analyze the independent risk factors of the visceral pleural invasion. Results Visceral pleural invasion was observed in 61/249 of the cases. Gender, the largest diameter, type, spiculated sign, lobulated sign, DLP and relationship of nodule and visceral pleura between the two groups were significantly different （P〈0.05）.Multivariate Logistic regression analysis showed that the largest diameter and spiculated sign of nodules were independent risk factors for visceral pleural invasion.Visceral pleural invasion was uncommon in Type Ⅰ.The probability of the visceral pleural invasion in type Ⅱ, type Ⅲ and type Ⅳ was 0.023 times （ 95% CI：0.006- 0.093 ） , 0.225 times （95% CI：0.078 -0.648） and 0.645 times （95% CI：0.261-2.300） as much as that of type Ⅴ , respectively. Visceral pleural invasion was more likely to occur in Type Ⅴ than other types （P〈0.05）. Conclusion The largest diameter and spiculated sign are independent predictors for visceral pleural invasion in non-small cell lung cancer with the largest diameter less than or equal to 3 cm.Nodules closely adjacent to the pleura are more likely to invade the visceral pleural.

关 键 词：非小细胞肺癌 脏层胸膜侵犯 计算机体层成像 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]