中央型和周围型肺鳞癌患者淋巴结转移的影响因素分析  

Analysis of influencing factors of lymph node metastasis in patients with central and peripheral types of squamous cell lung cancer

作　　者：李淼[1] 王长利 LI Miao;WANG Chang-li(Tianjin Haihe Hospital,Tianjin 300350,China;Tianjin Medical University Cancer Institute and Hospital)

机构地区：[1]天津市海河医院,300350 [2]天津医科大学肿瘤医院

出　　处：《天津医药》2018年第6期635-639,共5页Tianjin Medical Journal

摘　　要：目的分析中央型和周围型肺鳞癌患者淋巴结转移相关的因素,以期为术前准备、术中淋巴结处理方式选择及术后治疗提供循证学依据。方法回顾性分析天津医科大学肿瘤医院2014年1月—2015年12月行肺癌手术的142例患者的临床资料,包含中央型肺鳞癌83例,周围型肺鳞癌59例。分别采用单因素和多因素Logistic回归分析不同类型患者性别、年龄、吸烟史、吸烟指数、术前CYFRA21-1表达情况、术前淋巴结转移评估、肿瘤最大径、肿瘤类型(角化型与非角化型)、有无胸膜侵犯、肿瘤周围脉管内有无癌栓等临床特征与淋巴结转移的关系。结果 142患者中淋巴结转移者共47例,包括中央型转移31例,周围型转移16例。单因素分析显示性别、吸烟史、吸烟指数、术前淋巴结转移评估情况、肿瘤直径和非角化型等因素与中央型肺鳞癌淋巴结转移有关;胸膜侵犯、非角化型与周围型肺鳞癌淋巴结转移有关。多因素Logistic回归分析显示,高吸烟指数、肿瘤直径较大、非角化型均为中央型肺鳞癌淋巴结转移的独立危险因素;非角化型为周围型肺鳞癌淋巴结转移的独立危险因素。结论非角化型鳞癌成分与肺鳞癌淋巴结尤其N1淋巴结转移关系密切,建议术后积极治疗密切随访。吸烟越多可能越易出现N2淋巴结转移。Objective To analyze the factors related to the metastasis of lung squamous cell carcinoma in patients with central and peripheral types of lung squamous carcinoma, and provide evidence-based basis for preoperative preparation, intraoperative lymph node treatment choice and postoperative treatment. Methods Clinical data of 142 patients with lung squamous carcinoma who performed operation in Tianjin Medical University Cancer Institute and Hospital from January 2014 to December 2015 were retrospectively analyzed. There were 83 cases of central lung squamous cell carcinoma and 59 cases of peripheral lung squamous carcinoma in these 142 patients. Single factor and multiple factor Logistic regression analysis were used to analyze the clinical data in patients with different type groups, including gender, age, smoking history and smoking index, preoperative CYFRA21-1 level, preoperative predictive lymph nodes metastasis, tumor diameter, tumor type （keratotic and non-keratotic）, pleura invasion, tumor embolism and postoperative lymph node metastasis. Results There were 47 cases with lymph node metastasis in 147 patients, including 31 cases of central type metastasis, and 16 cases of peripheral type metastasis. Single factor analysis showed that gender, smoking history, smoking index, preoperative lymph node metastasis assessment, tumor diameter, and non-keratotic type were related to the metastasis of central type of lung squamous cell carcinoma. Pleural invasion and non-keratotic type were associated with peripheral type of puhnonary squamous cell carcinoma. Multivariate Logistic regression analysis showed that more smoking, large tumor diameter and non- keratotic type were independent risk factors for lymph node metastasis of central type of lung squamous cell carcinoma. The non-keratotic type was an independent risk factor for lymph node metastasis of peripheral puhnonary squamous carcinoma. Conclusion Non-keratotic type of squamous cell carcinoma is related to lymph node metastasis especially N1 lymph node metas

关 键 词：肺肿瘤 癌 鳞状细胞 淋巴转移 危险因素 中央型肺癌 周围型肺癌 非角化型 

分 类 号：R734.2[医药卫生—肿瘤]