薄层CT预判肺亚实性结节长期随访过程中生长的危险因素  

Prediction of Risk Factors for the Growth of Subsolid Pulmonary Nodules on Thin-Section CT During Long-Term Follow-Up

作　　者：贺祎凡 熊梓琦 张靖雨 牛愉鑫 李智勇[1] HE Yifan;XIONG Ziqi;ZHANG Jingyu(Department of Radiology,The First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning Province 116011,P.R.China)

机构地区：[1]大连医科大学附属第一医院放射科,116011

出　　处：《临床放射学杂志》2023年第12期1907-1912,共6页Journal of Clinical Radiology

基　　金：大连市科技创新基金项目(编号:2022JJ13SN078)。

摘　　要：目的探究长期随访的亚实性结节(SSN)生长自然史、生长速率及出现后续生长的危险因素,以助于临床制定合理的随访管理策略。方法回顾性纳入132例患者的149个SSN。通过手动分割获得每个SSN的直径、整体平均CT值(m-CTA)、体积,随后计算质量、体积倍增时间(VDT)和质量倍增时间(MDT)。将结节分为生长组和非生长组,比较两组间基线临床特征及影像学特征的差异。使用Kaplan-Meier曲线和多因素COX比例风险回归分析影响SSN生长的独立危险因素。结果所有纳入SSN的随访时间为376.0~4703.0天,中位随访时间为1313.0天。88个(59.1%)SSN出现生长,VDT为156.3~6799.0天,MDT为142.3~7264.5天,中位VDT为1093.7天,中位MDT为1003.9天。多因素COX风险回归分析表明,年龄≥68岁(HR=2.965,P<0.001),初始m-CTA≥-487 HU(HR=2.313,P=0.017)和存在空泡(HR=1.870,P=0.008)是影响SSN生长的独立危险因素。结论SSN总体呈惰性生长过程。老年人、具有空泡和较大初始m-CTA是生长的独立危险因素。Objective To explore the natural course of growth,growth rate,and risk factors for the appearance of subsequent growth in subsolid nodules(SSN)with long-term follow-up,in order to help clinical formulation of a reasonable follow-up management strategy.Methods This study retrospectively enrolled 149 SSNs from 132 patients.The diameter,overall mean-CT attenuation(m-CTA),and volume of each SSN were obtained by manual segmentation,followed by calculation of mass,volume doubling time(VDT),and mass doubling time(MDT).SSNs were divided into growth and non-growth groups,and the differences in baseline clinical and radiological features between the two groups were compared.Independent risk factors affecting SSN growth were analyzed using Kaplan-Meier curves and multivariate Cox proportional risk regression.Results The median follow-up time for 149 SSNs was 1313.0(range:376.0-4703.0)days.Eighty-eight(59.1%)SSNs showed growth with median VDT and MDT of 1093.7(range:156.3-6799.0)and 1003.9(range:142.3-7264.5)days,respectively.Multivariate Cox risk regression analysis showed that age≥68 years(HR=2.965,P<0.001),initial m-CTA≥-487 HU(HR=2.313,P=0.017)and vacuole sign(HR=1.870,P=0.008)were independent risk factors for SSN growth.Conclusion SSNs show an indolent growth course.In older adults,SSNs with vacuole signs and larger initial m-CTAs may be of greater concern,as these factors are significantly associated with SSNs growth.

关 键 词：亚实性结节 生长 倍增时间 危险因素 

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