肺结节直径等因素与其侵袭性的关系  

Relationship between factors such as the diameter of pulmonary nodules and their invasiveness

作　　者：尹永杰 苏世红[1] 徐爱晖[1] YIN Yong-jie;SU Shi-hong;XU Ai-hui(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院呼吸与危重症学科,安徽合肥230022

出　　处：《临床肺科杂志》2023年第4期523-528,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的探究肺结节直径等因素对其侵袭性判断的意义。方法回顾性分析1290例肺结节资料,按病理结果分为侵袭与非侵袭组,将侵袭组按有无淋巴结转移进一步分为两亚组。分别对各组间人口学、影像学资料进行对比,采用多因素Logistic回归及广义相加模型平面曲线拟合探讨肺结节直径与其发生侵袭及淋巴结转移间的相关性,受试者工作(ROC)曲线探索结节直径临界值及诊断性能。结果在各影响因素中,肺结节是否发生侵袭及淋巴结转移均与结节直径相关性最强,广义相加模型平滑曲线拟合结果表明结节直径与其侵袭及淋巴结发生风险的变化趋势呈线性相关(P<0.05)。ROC曲线分析表明区分肺结节侵袭及淋巴结转移的结节直径最佳分界值分别为12.35 mm(AUC=0.817,95%CI:0.794~0.84,灵敏度73.7%,特异度74.4%)、15.55 mm(AUC=0.747,95%CI:0.686~0.808,灵敏度93.5%,特异度52%)。结论肺结节在直径<12.35 mm时,发生侵袭风险较低;直径>15.55 mm时,发生淋巴结转移风险较高。年龄、亚实性结节、有无空泡征、血管征、分叶征可作为评估肺结节是否侵袭的综合评估因素。Objective To investigate the diameter of pulmonary nodules on their invasiveness determination.Methods The data of 1290 pulmonary nodules were retrospectively analyzed and divided into the invasive and non-invasive groups according to pathological findings,and the invasive group was then separated into two subgroups according on whether or not lymph node metastases was present.The demographic and imaging data were compared among the groups separately,and the correlation between the diameter of pulmonary nodules and their occurrence of invasion and lymph node metastasis was explored using multifactorial logistic regression and smooth curve fitting of generalized additive model.The receiver operating characteristic curve(ROC)was explored for the critical value of the diameter of nodules and diagnostic performance.Results Among the influencing factors,the occurrence of invasion and lymph node metastasis were most strongly correlated with nodal diameter.Smooth curve fitting of generalized additive model analysis showed that nodal diameter was linearly correlated with the risk of invasion and lymph node occurrence.Receiver operating characteristic curve indicated that the best value of the nodal diameter for differentiating invasive nodes invasion and lymph node metastasis in lung nodal patients was 12.35 mm(AUC=0.817,95%CI:0.794~0.84,sensitivity 73.7%,specificity 74.4%)and 15.55 mm(AUC=0.747,95%CI:0.686~0.808,sensitivity 93.5%,specificity 52%).Conclusion Lung nodules have a low risk of invasion when the diameter is below 12.35 mm and a high risk of lymph node metastasis when the diameter is above 15.55 mm.Age,subsolid nodules,vacuolar signs,vascular signs,and lobar signs could be used as a comprehensive assessment factor to evaluate whether pulmonary nodule is invasive.

关 键 词：肺结节 肺癌 手术指标 侵袭 淋巴结转移 

分 类 号：R734.2[医药卫生—肿瘤]