IA期孤立结节型浸润性粘液性肺腺癌的CT特征及预测模型的建立  

Computed tomography features and prediction model of stage-IA solitary nodular invasive mucinous lung adenocarcinoma

作　　者：张磊[1] 沈文荣[1] 张秀明[1] 于韶荣[1] 姜久艳[1] 吴梦婕 史丹 尹娜[1] ZHANG Lei;SHEN Wenrong;ZHANG Xiuming;YU Shaorong;JIANG Jiuyan;WU Mengjie;SHI Dan;YIN Na(Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009 China)

机构地区：[1]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院,江苏南京210009

出　　处：《中国辐射卫生》2023年第2期171-175,181,共6页Chinese Journal of Radiological Health

基　　金：江苏省健康委科研项目(BJ19032);南京医科大学附属肿瘤医院科技基金项目(ZL202213);国家自然科学基金面上项目(82172872)。

摘　　要：目的 探讨IA期孤立结节型浸润性粘液性肺腺癌(Invasive mucinous lung adenocarcinoma,IMA)的CT特征以及建立预测模型。方法 收集我院2 017年1月—2 019年12月经临床手术病理证实为IA期IMA 53例患者53个病灶,以及浸润性非粘液性肺腺癌(Invasive non-mucinous lung adenocarcinoma,NIMA)141例患者141个病灶作为对照,行单因素分析比较2组在人口统计学及CT征象上的差异,多因素logistic回归分析明确孤立结节型IMA的主要影响因素,并以主要影响因素的回归系数为基础建立risk score(风险评分)预测模型,最后用ROC(受试者操作特征)曲线评估此模型的预测效能。结果 单因素分析显示2组在年龄、结节的最长直径、瘤肺界面、分叶、毛刺、支气管充气征或空泡征、血管异常改变间差异有显著统计学差异(P <0.05),且毛刺征在两者之间的CT表现不同,前者较长且软,后者较短且硬;在性别、结节形状、胸膜牵拉方面差异无统计学意义(P> 0.05),但不规则形态在IMA中出现率相对稍高。多因素logistic回归结果提示瘤肺界面模糊(OR=20.930;P <0.05)、支气管充气征或空泡征(OR=7.126;P <0.05)、毛刺(OR=4.207,P <0.05)、血管异常改变(OR=0.147;P <0.05)是主要影响因素,基于主要影响因素的回归系数建立预测模型,并绘制受试者工作曲线(ROC),曲线下的面积为0.829(P <0.05)。结论 与NIMA相比,IA期周围型孤立结节型IMA年龄更大,CT上更多表现出模糊的瘤肺界面以及支气管充气征或空泡征;毛刺较长且软。依据瘤肺界面、支气管充气征或空泡征、毛刺、血管异常改变为主要影响因素的回归系数而建立的risk score预测模型对孤立结节型IMA具有较好的预测效果。Objective To investigate the computed tomography(CT)features of solitary nodular invasive mucinous lung adenocarcinoma(IMA)in stage IA and establish its prediction model.Methods We included 53 lesions of 53 patients with stage-IA IMA and 141 control lesions of 141 patients with invasive non-mucinous lung adenocarcinoma(NIMA)that were confirmed by surgical pathology in our hospital from January 2017 to December 2019.Univariable analysis was used to compare the demographics and CT signs of the two groups.Multivariable logistic regression analysis was performed to determine the main factors influencing solitary nodular IMA.A risk score prediction model was constructed based on the regression coefficients of the main influencing factors.A receiver operating characteristic(ROC)curve was used to assess the performance of the model.Results The univariable analysis showed significant differences between the two groups in age,largest nodule diameter,tumor-lung interface,lobulation,spiculation,air-bronchogram or vacuole sign,vessel abnormalities(P<0.05).The spiculation sign was different between the two groups,which was longer and softer in the IMA group while shorter and harder in the NIMA group.There was no significant difference in sex,nodule shape,or pleural retraction(P>0.05),but irregular shapes were slightly more frequent in the IMA group.The multivariable logistic regression analysis showed that obscure tumor-lung interface(odds ratio(OR=20.930,P<0.05),air-bronchogram or vacuole sign(OR=7.126,P<0.05),spiculation sign(OR=4.207,P<0.05),and vessel abnormalities(OR=0.147,P<0.05)were the main influencing factors.The prediction model based on those factors’regression coefficients had an area under the ROC curve of 0.829(P<0.05).Conclusion Compared with those with NIMA,patients with solitary nodular IMA in stage IA were older and more likely to have the CT features of obscure tumor-lung interface,air-bronchogram or vacuole sign,and longer and softer spiculation.Based on the regression coefficients of tumor-lung interfac

关 键 词：浸润性粘液性肺腺癌 影响因素 risk score模型 

分 类 号：R816[医药卫生—放射医学]