早期≤30 mm非小细胞肺癌脏层胸膜侵犯的多因素分析  

Multifactorial Analysis of Visceral Pleural Invasion in Early Stage≤30 mm Non-Small Cell Lung Cancer

作　　者：刘艳 吴艳[2,3] 王健 孙宜楠[2] 谢宗玉 史恒峰 LIU Yan;WU Yan;WANG Jian(Bengbu Medical University,Bengbu,Anhui Province 233000,P.R.China)

机构地区：[1]蚌埠医科大学,233000 [2]安庆市立医院,246000 [3]皖南医学院,芜湖241000 [4]浙江省立同德医院,杭州310012 [5]蚌埠医科大学第一附属医院,233000

出　　处：《临床放射学杂志》2024年第10期1690-1696,共7页Journal of Clinical Radiology

基　　金：安徽省高等学校科学研究重点项目(编号:2023AH050608)。

摘　　要：目的探索早期≤30 mm非小细胞肺癌(NSCLC)发生脏层胸膜侵犯(VPI)影响因素。方法回顾性分析安庆市立医院、浙江省立同德医院及蚌埠医科大学第一附属医院2021年1月至2023年11月经术后病理诊断为早期NSCLC的449例患者的临床、影像及病理资料,根据患者是否发生VPI分为两组,单因素及多因素回归分析NSCLC发生VPI的影响因素。结果449例患者中VPI阳性组121例,VPI阴性组328例。单因素分析显示VPI阳性组病灶直径及实性部分与胸膜接触长度均明显大于VPI阴性组,CT值均较高;患者年龄、肺部疾病史及临床疾病、病灶结节类型及实性成分占比、形态、分叶征、毛刺征、含气腔隙、支气管征、病灶与胸膜的关系、胸膜标签数量及阻塞性炎症在VPI阳性组和VPI阴性组间的差异均有统计学意义(P值<0.05),多因素回归分析显示结节类型、胸膜标签数量、病灶实性部分与胸膜接触长度、CT值为NSCLC VPI的CT特征指标。这些因素单独及联合预测胸膜侵犯的曲线下面积(AUC)分别为0.796、0.770、0.832、0.754、0.966。联合模型的敏感度、特异度与准确率分别为90.1%、92.1%、90.9%。结论NSCLC病灶发生VPI时病灶多表现为实性成分占比高的部分实性结节及实性结节,且CT值较高,病灶实性部分与胸膜接触长度长且具有多根胸膜标签时发生VPI的概率大。Objective Exploring factors influencing the occurrence of visceral pleural invasion(VPI)in early stage≤30 mm non-small cell lung cancer.Methods The clinical,imaging and pathological data of 449 patients diagnosed as early-stage non-small cell lung cancer by postoperative pathology in Anqing Municipal Hospital,Zhejiang Tongde Hospital and the First Affiliated Hospital of Bengbu Medical University during the period of January 2021-November 2023 were retrospectively analyzed,and the patients were divided into two groups according to whether they had developed VPI or not,and the influencing factors of the development of VPI in non-small cell lung cancer were analyzed by unifactorial and multifactorial regression.Results Among the 449 patients,121 were in the VPI-positive group and 328 were in the VPI-negative group.Univariate analysis showed that the diameter of the lesion and the length of contact between the solid part and the pleura in the VPI(+)group were significantly larger than those in the VPI(-)group,and the CT values were higher;the age of the patients,history of lung diseases and clinical diseases,type of nodules and percentage of solid component of the lesion,morphology,lobular sign,burr sign,air-containing lumen,bronchial sign,the relationship of the lesion to the pleura,the number of pleural tags and obstructive inflammation were all statistically significant in the VPI(+)groups and VPI(-)groups were statistically significant(P value<0.05),and multifactorial regression analysis showed that nodule type,number of pleural tags,length of contact between the solid part of the lesion and the pleura,and CT value were the CT characteristic indexes of pleural invasion in non-small cell lung cancer.The areas under the curve of these factors individually and jointly predicted pleural invasion were 0.796,0.770,0.832,0.754,and 0.966,respectively.The sensitivity,specificity,and accuracy of the combined model were 90.1%,92.1%,and 90.9%,respectively.Conclusion When pleural invasion occurred in non-small cell lung can

关 键 词：非小细胞肺癌 脏层胸膜侵犯 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]