基于最新浸润性肺腺癌分级系统的手术前CT影像特征分析及预后评估  

Analysis of preoperative CT image features and prognostic assessment based on the latest classification system for invasive lung adenocarcinoma

作　　者：薛阳 杜学松 杨博 沈桂萍 刘江勇 黄文才 熊飞 XUE Yang;DU Xue-song;YANG Bo(Department of Radiology,General Hospital of Central Theater Command,Wuhan 430070,China)

机构地区：[1]中部战区总医院放射诊断科,武汉430070

出　　处：《放射学实践》2023年第9期1121-1128,共8页Radiologic Practice

基　　金：湖北省重点研发计划项目(一般项目)(2020BCB059)。

摘　　要：目的:探讨手术前CT影像特征与浸润性肺腺癌不同病理分级的相关性,预测手术患者预后。方法:回顾性分析184例(共188个结节,其中4例患者有2个病灶,病理亚型不同)经手术病理证实的浸润性肺腺癌患者的手术前CT图像,依据2020年IASLC病理学委员会设定的肺腺癌分级系统将其病理分为低、中、高分化三组,分析不同病理分级与手术前CT图像中病灶实变程度、病灶最大长径、病灶内部情况及周围结构的相关性。排除4例多灶性腺癌患者后,分析180例患者CT影像特征在不同病理分级患者预后中的预测价值。结果:通过秩和检验与单因素有序Logistic回归共同验证比较发现,病变实变程度、病灶最大长径、病灶与血管相关性、边缘晕征、胸膜凹陷征、分叶征、毛刺征、淋巴结肿大在低、中、高分化三组间差异均有统计学意义(P<0.05);多因素分析结果显示病灶实变程度是不同病理分级的风险因素(OR=2.757,P<0.05)。患者预后随访结果显示低分化组预后更差,单因素生存分析发现男性、病灶呈实性、病灶内部出现血管、支气管截断征、微小钙化征、周围出现卫星灶、同侧肺门淋巴结肿大是影响患者生存时间的风险因素(P<0.05);多因素生存分析发现男性患者(HR=2.658,P<0.05)及同侧肺门淋巴结肿大(HR=4.736,P<0.05)是患者手术后复发的风险因素。结论:手术前CT影像特征可预测浸润性肺腺癌的病理分级程度及手术预后情况,可指导临床制定合适的治疗方案。Objective:To investigate the correlation between preoperative CT imaging features and different pathological grades of invasive lung adenocarcinoma and further to predict the prognosis of patients with surgery.Methods:One hundred eight-four cases(188 nodules,including 4 patients with two lesions,different pathological subtype)of invasive lung adenocarcinoma with preoperative CT images were collected.According to the classification system of lung adenocarcinoma by IASLC Pathology Committee in 2020,the pathology of lung adenocarcinoma was divided into low,medium and high differentiation groups.The correlation between different pathological grade and preoperative CT features including lesion consolidation,maximum diameter,intra-lesion features and surrounding structure were explored.Four patients with multifocal adenocarcinoma were excluded,and the prognostic value of CT image features in 180 patients with different pathological grades was compared.Results:There were statistical differences in different pathological grades using rank sum test and single factor test for lesion consolidation degree,maximum lesion diameter,lesion and vascular correlation,marginal halosis sign,pleural depression sign,lobulating sign,burr sign and lymph node enlargement(P<0.05).Multivariate analysis showed that the degree of lesion consolidation was a risk factor for different pathological grades(OR=2.757,95%CI 1.947~3.904,P<0.05).In following-up of patients'prognosis,there was a worse prognosis for low differentiation group.All of risk factors including males,solid lesions,internal vascular and bronchial truncation signs,micro-calcification signs,peripheral satellite lesions,and ipsilateral hilar lymph node enlargement were affecting the survival of patients in univariate survival analysis(P<0.05).Male patients(HR=2.658,95%CI 1.014~6.966,P<0.05)and ipilateral hilar lymph node enlargement(HR=4.736,95%CI 1.257~17.843,P<0.05)were risk factors for postoperative recurrence in multivariate survival analysis.Conclusion:Preoperative CT imaging

关 键 词：肺肿瘤 浸润性肺腺癌 体层摄影术 X线计算机 病理分级 预后 

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