薄层CT扫描在区分多发性肺癌和肺磨玻璃结节成分及预后评估中的价值  

The impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity

作　　者：宣煜龙[1] 史敏科[1] Xuan Yulong;Shi Minke(Department of Cardio-thoracic Surgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属南京鼓楼医院心胸外科,210008

出　　处：《中华胸部外科电子杂志》2018年第4期213-218,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的通过薄层CT扫描区分多发性肺癌和肺磨玻璃结节(GGO)成分,并评估其预后影响因素。方法回顾性分析3 254例Ⅰ期肺癌行手术切除患者,其中312例(9.6%)为多发性肺癌,所有患者根据GGO大小、薄层CT上的肿瘤实性成分比值(CTR)分为磨玻璃成分为主(GD)(0≤CTR <0.5)、实性成分为主(SD)(0.5≤CTR <1.0)、纯实性(PS)(CTR=1.0)。根据影像学结果将多发性肺癌患者分为6组:GD+GD组、GD+SD组、GD+PS组、SD+SD组、SD+PS组和PS+PS组。采用Cox比例风险模型对比临床Ⅰ期肺癌患者的预后情况。结果 312例多发性肺癌患者中,251例(80.4%)切除了2个以上肿瘤同时病理诊断为多发性肺部肿瘤。其中GD+GD患者90例(28.8%),GD+SD患者70例(22.4%),GD+PS患者66例(21.2%),SD+SD患者16例(5.1%),SD+PS患者27例(8.7%),PS+PS患者43例(13.8%)。多变量分析显示,PS+PS是影响预后的独立危险因素(P<0.001)。整体生存率分别为GD+GD组96.7%,GD+SD组98.6%,GD+PS组84.8%,SD+SD组93.8%,SD+PS组77.8%,PS+PS组41.9%。PS+PS组与其他组相比差异均有统计学意义(P<0.05)。此外,剩余2 942例Ⅰ期肺癌患者的整体生存率为78.2%,与PS+PS组相比差异也有统计学意义(P<0.001),而其他组与剩余患者相比预后类似甚至更好。结论在多发性肺癌患者中,PS+PS组患者生存率更低,这可能促进T分期更新,多发肺癌患者GGO影像学形态及其类型对预后评估极其重要。Objective The purpose of this study is to evaluate the impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity.Methods We reviewed the clinical data of 3254 surgically resected c-stage I lung cancer patients, 312 （9.6%）with multiple lung tumors. All patients were classified into 3 groups based on the extent of ground glass opacity （GGO） and consolidation tumor ratio （CTR）, including GGO-dominant （GD）（0 ≤CTR 〈 0.5）, solid-dominant （SD） （0.5 ≤CTR 〈 1.0） ,and pure-solid （PS） （CTR =1.0）. Patients with multiple lung tumors were divided into 6 groups based on imaging findings,including GD＋GD group, GD＋SD group, GD＋PS group, SD＋SD group, SD＋PS group and PS＋PS group , and their prognoses were compared with that of c-stage I lung cancer using Cox’s proportional hazard model.Results Among all, 251（80.4%） have surgically resected more than two tumors and pathologically determined as multiple lung cancers patients . Among 312 patients , 90 in GD＋GD group （28.8%）, 70 in GD ＋SD group（22.4%）, 66 in GD＋PS group（21.2%）, 16 in SD ＋SD group （5.1%）, 27 in SD＋PS group（8.7%）,and 43 in PS ＋PS group（13.8%）. Based on the results of multivariate analyses, PS＋PS revealed the independent risk factors for prognosis impact（ P 〈0.001）. The overall survival rate （OS） was 96.7% in group GD＋GD, 98.6% in group GD ＋SD, 84.8% in group GD＋PS , 93.8% in group SD＋SD ,77.8% in group SD＋PS , 41.9% in group PS ＋PS , which showing a significant difference between PS＋PS group and the other groups （ P 〈0.05）.Conclusions Among all patients with multiple lung cancers, patients in PS＋PS group have lower survival rate, which would contribute to the upstaging of T descriptors. The imaging findings of GGO and its classifications are extremely important to prognosis evaluation.

关 键 词：多发性肺癌 磨玻璃结节 影像学表现 预后 

分 类 号：R734.2[医药卫生—肿瘤]