非小细胞肺癌肺叶切除及淋巴清扫术后11s组淋巴结转移规律及危险因素分析  

Analysis of lymph node metastasis and risk factors in 11s group after lobectomy and lymph node dissection in patients with non-small cell lung cancer

作　　者：毛宇[1] 白艳艳[2] 黎明[1] 乔文婷 赵素清[3] MAO Yu;BAI Yanyan;LI Ming;QIAO Wenting;ZHAO Suqing(Department of Thoracic Surgery,First Hospital of Hohhot,Hohhot 010030,China;Department of Anesthesiology,First Hospital of Hohhot,Hohhot 010030,China;Health Management Center,First Hospital of Hohhot,Hohhot 010030,China)

机构地区：[1]呼和浩特市第一医院胸外科,内蒙古呼和浩特010030 [2]呼和浩特市第一医院麻醉科,内蒙古呼和浩特010030 [3]呼和浩特市第一医院健康管理中心,内蒙古呼和浩特010030

出　　处：《中国肿瘤外科杂志》2023年第2期141-148,共8页Chinese Journal of Surgical Oncology

基　　金：国家自然基金(819660577);呼和浩特市科技计划项目(2021-社-10)。

摘　　要：目的探讨右肺下叶非小细胞肺癌(NSCLC)患者行肺叶切除及系统性淋巴结清扫术后11s组淋巴结转移规律及危险因素分析。方法选取2017年1月至2022年12月于呼和浩特市第一医院行肺叶切除及淋巴清扫术治疗的右肺下叶NSCLC患者318例为研究对象,依据随机数表法分为训练集(223例)和验证集(95例),其中训练集根据术后病理结果分为11s转移组(108例)和11s未转移组(115例)。分析两组患者的临床资料及11s组淋巴结转移规律;多因素Logistic回归分析影响NSCLC患者11s组淋巴结转移的危险因素并使用R软件构建列线图模型;采用受试者工作特征曲线(ROC)和校准曲线评价模型区分度和准确性。结果318例NSCLC患者11s组淋巴结转移156例,转移率49.06%。单因素分析显示,训练集11s转移组和11s未转移组在病理组织学、肿瘤最大径、影像学毛刺征、2R+4R组淋巴结转移、7组淋巴结转移、Hcy、CysC、CEA、CA-199、ProGRP差异有统计学意义(P<0.05)。多因素分析显示,影像学呈毛刺征、2R+4R组转移、7组转移、Hcy≥16.83μmol/L、CysC≥1.52 mg/L、CEA≥20.37 ng/ml、CA-199≥42.16 U/ml、ProGRP≥1179.45μg/L是NSCLC患者发生11s组淋巴结转移的独立影响因素(P<0.05)。列线图模型显示,2R+4R组淋巴结受侵、7组淋巴结受侵、血清CEA水平所占权重均较高,预测风险值为0.92。模型验证显示,训练集和验证集ROC曲线下面积分别为0.869(95%CI:0.786~0.915,P<0.001)和0.912(95%CI:0.863~0.981,P<0.001),一致性指数分别为0.873和0.947,校准曲线Hosmer-Lemeshow检验结果差异均无统计学意义(P>0.05)。结论在淋巴结各站点中,2R+4R组、7组受侵是11s组淋巴结转移的危险因素。术前影像学呈毛刺征、血清Hcy、CysC、CEA、CA-199、ProGRP水平过高也是NSCLC患者发生11s组淋巴结转移的危险因素,基于此构建的列线图模型区分度良好、准确度较高。Objective To investigate the regularity and risk factors of lymph node metastasis in 11s group after lobectomy and systematic lymph node dissection in patients with right lower lobe non-small cell lung cancer(NSCLC).Methods Three hundred and eighteen patients with right lower lobe NSCLC who underwent lobectomy and lymphadenectomy in First Hospital of Hohhot from January 2017 to December 2022 were divided into training set(n=223)and verification set(n=95)by the method of random number table.According to the postoperative pathological results,the training group was divided into 11s metastasis group(n=108)and 11s non-metastasis group(n=115).The clinical data of the two groups and the rule of lymph node metastasis in 11s group were analyzed.Multivariate logistic regression analysis was used to analyze the risk factors of lymph node metastasis in 11s group of NSCLC patients.R software was applied to build the line diagram model.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the differentiation and accuracy of the model.Results Lymph node metastasis was occurred in 156 NSCLC patients with a metastasis rate of 49.06%.Univariate analysis showed that there were significant differences on the result of histopathology,maximum diameter of tumor,imaging of spiculation sign,lymph node metastasis in 2R+4R group,lymph node metastasis in 7 groups,Hcy,CysC,CEA,CA-199 and ProGRP between 11s metastasis group and 11s non-metastasis group.Multivariate analysis showed that spiculation sign,metastasis in 2R+4R group,metastasis in 7 groups,Hcy≥16.83μmol/L,CysC≥1.52 mg/L,CEA≥20.37 ng/ml,CA-199≥42.16 U/ml and ProGRP≥1179.45μg/L were independent influencing factors of lymph node metastasis in 11s group of NSCLC patients.The line diagram model showed that the weights of lymph node invasion in 2R+4R group,lymph node invasion in 7 groups and serum CEA level were higher.The risk value predicted by the model was 0.92.Model verification shows that the area under the ROC curve of the trainin

关 键 词：非小细胞肺癌 淋巴结清扫 11s组淋巴结 列线图模型 

分 类 号：R734.2[医药卫生—肿瘤]