循环肿瘤细胞联合低剂量螺旋CT对恶性孤立性肺结节病理浸润的预测价值  

Predictive value of circulating tumor cells combined with low-dose helical computed tomography for the pathological invasion in malignant solitary pulmonary nodules

作　　者：尤培林 丁运 郭天兴[1,2] 朱立桓 陈文树[1,2] 黄阳昀 李武锦 潘小杰[1,2] You Peilin;Ding Yun;Guo Tianxing;Zhu Lihuan;Chen Wenshu;Huang Yangyun;Li Wujin;Pan Xiaojie(Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Department of Thoracic Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院胸外科,福州350001

出　　处：《中华实验外科杂志》2021年第2期360-363,共4页Chinese Journal of Experimental Surgery

基　　金：福建省科技引导性项目(2017Y0018)。

摘　　要：目的探讨循环肿瘤细胞(CTC)联合低剂量螺旋CT(LDCT)对恶性孤立性肺结节(MSPN)病理浸润的预测价值。方法2018年7月至2019年5月于福建省立医院胸外科连续收治120例LDCT检出的孤立性肺结节(SPN)患者。术前检测CTC、测量LDCT上肺结节实性成分占比(Cdmax/Td),以术后病理为诊断金标准,采用受试者工作特征(ROC)曲线评估CTC、CTC联合LDCT对MSPN病理浸润的预测价值,并采用χ^(2)检验或Fisher精确概率法分析CTC与MSPN患者临床特征的相关性。结果120例SPN中,恶性肺结节102例(85%),其中肺腺癌97例(81%);含浸润成分的MSPN[包括微浸润性腺癌(MIA)、浸润性腺癌(IAC)]CTC明显高于不含浸润成分的MSPN[原位腺癌(AIS)][10.65(9.05~12.70)比8.00(6.85~10.20)FU/3 ml,Z=-3.119,P<0.05];CTC、Cdmax/Td预测MSPN是否含浸润成分的曲线下面积(AUC)分别为0.770、0.855;CTC联合Cdmax/Td预测MSPN是否含浸润成分的AUC大于Cdmax/Td,差异有统计学意义(0.914比0.855,Z=2.243,P<0.05)。单因素分析结果表明CTC与肺腺癌LDCT肿瘤最大径(Td)、病理分期、淋巴结转移明显相关(χ^(2)=7.118、14.474、4.368,P<0.05),与恶性结节脉管侵犯、胸膜侵犯、表皮生长因子受体(EGFR)突变无相关(χ^(2)=1.601、0.822、0.457,P>0.05)。结论CTC对MSPN病理浸润具有预测价值;CTC联合LDCT对MSPN病理浸润的预测价值优于单纯影像预测;CTC与Td、淋巴结转移、术后TNM分期呈正相关。Objective To explore the predictive value of circulating tumor cells(CTCs)combined with low-dose helical computed tomography(LDCT)for the pathological invasion of malignant solitary pulmonary nodules(MSPNs).Methods From July 2018 to May 2019,120 consecutive patients with solitary pulmonary nodules(SPNs)detected by LDCT were recruited from the Department of Thoracic Surgery in Fujian Provincial Hospital.CTCs were detected and ratio of the greatest diameter of consolidation found to the greatest diameter of tumor on all LDCT(cutCdmax/Td)was measured preoperatively.The postoperative pathology was taken as the gold standard for the diagnosis of pathological invasion of MSPNs.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of CTCs,Cdmax/Td and CTCs combined with Cdmax/Td for the pathological invasion.Results In the 120 cases of SPNs,there were 102(85%)cases of MSPNs,including 97(81%)cases of lung adenocarcinoma.The level of CTCs in MSPNs containing invasive components[including microinvasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC)]was significantly higher than that in MSPNs without invasive components[adenocarcinoma in situ(AIS)][10.65(9.05-12.70)vs.8.00(6.85-10.20)FU/3 ml,Z=-3.119,P<0.05].The area under the ROC curve(AUC)for CTCs and Cdmax/Td was 0.770 and 0.855 respectively.The area under curve(AUC)for CTCs combined with Cdmax/Td was greater than that of Cdmax/Td(0.914 vs.0.855,Z=2.243,P<0.05).Univariate analysis showed that CTCs were significantly associated with the maximum diameter of tumor on imaging,lymph node metastasis and pathological stage in lung adenocarcinoma(χ^(2)=7.118,14.474,4.368,P<0.05),while there was no significant correlation with vascular invasion,pleural invasion and epidermal growth factor receptor(EGFR)mutation in malignant nodules(χ^(2)=1.601,0.822,0.457,P>0.05).Conclusion CTCs have predictive value for the pathological invasion of MSPNs.The value of CTCs combined with LDCT in predicting the pathological invasion of MSPNs is greater than th

关 键 词：循环肿瘤细胞 螺旋CT 肺结节 肺腺癌 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]