周围型非小细胞肺癌纵隔淋巴结转移影响因素及临床意义  

Risk factors and clinical significance of mediastinal lymph node metastasis of peripheral non-small cell lung cancer

作　　者：王娟[1,2] 齐丽萍 李晓婷[1] 高顺禹[1] 孙应实[1] WANG Juan;QI Liping;LI Xiaoting;GAO Shunyu;SUN Yingshi(Department of Radiology,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research,Beijing 100142,China;Department of Radiology,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所医学影像科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学首钢医院医学影像科,北京100144

出　　处：《中国医学影像技术》2019年第10期1490-1494,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨周围型非小细胞肺癌(NSCLC)发生纵隔淋巴结转移的影响因素及其临床意义。方法回顾性分析45例术前胸部CT显示病灶同侧纵隔最大淋巴结短径≥10 mm(临床N2期)的周围型NSCLC患者的临床及CT检查资料,对周围型NSCLC纵隔淋巴结转移(病理分期为N2期)的影响因素进行单因素及多因素分析,并以病理结果为金标准,评价其诊断效能。结果术前CT诊断纵隔淋巴结转移的临床N2期NSCLC患者中,假阳性率为42.22%(19/45)。病灶同侧纵隔最大淋巴结短径(P=0.022)及术前血清癌胚抗原(CEA)水平(P=0.004)均为临床N2期周围型NSCLC纵隔淋巴结转移的影响因素;术前血清CEA水平为独立影响因素(P=0.007)。结合术前CT诊断及血清CEA水平进行筛选后,假阳性率降至7.69%(3/39)。结论术前血清CEA水平是临床N2期周围型NSCLC纵隔淋巴结转移的独立影响因素,有利于降低CT诊断假阳性率。Objective To investigate the risk factors and clinical significance of mediastinal lymph node metastasis in peripheral non-small cell lung cancer(NSCLC)patients.Methods Clinical and CT examinations data of 45 peripheral NSCLC patients with chest CT findings as ipsilateral mediastinal maximum lymph node diameter≥10 mm(clinical N2 stage)were retrospectively analyzed.Univariate and multivariate analyses were performed to identify the risk factors of mediastinal lymph node metastasis(pathological stage N2)in patients with peripheral NSCLC.The diagnostic efficacy of the risk factors was evaluated taken pathological results as the gold standards.Results The false positive rate of mediastinal lymph node metastasis was 42.22%(19/45)in clinical N2 NSCLC patients diagnosed with CT before surgery.The minimum diameter of mediastinal lymph node in ipsilateral side of NSCLC lesion(P=0.022)and serum carcinoembryonic antigen(CEA)level(P=0.004)were identified as risk factors for mediastinal lymph node metastasis.And serum CEA level(P=0.007)was identified as an independent factor by multivariate analysis.After screening with preoperative CT diagnosis and serum CEA level,the false positive rate of mediastinal lymph node metastasis decreased to 7.69%(3/39).Conclusion Preoperative serum CEA level is an independent factor for making definite diagnosis of mediastinal lymph node metastasis in clinical N2 stage patients with peripheral NSCLC,benefiting to reduce false positive rate of CT diagnosis.

关 键 词：癌 非小细胞肺 N2期 癌胚抗原 体层摄影术 X线计算机 

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