混杂磨玻璃结节肺腺癌淋巴结转移影响因素研究  

Study on the influencing factors of lymph node metastasis of lung adenocarcinoma with mixed ground glass nodules

作　　者：顾爽 范啸 史亮 王昱盛 孟超凡 王玉 汪潜云[1] Gu Shuang;Fan Xiao;Shi Liang;Wang Yusheng;Meng Chaofan;Wang Yu;Wang Qianyun(Department of Thoracic Surgery,Third Affiliated Hospital of Soochow University,Changzhou 213004,China;Department of Hepatobiliary Surgery,Jintan Affiliated Hospital of Jiangsu University,Changzhou 213200,China)

机构地区：[1]苏州大学附属第三医院胸外科,常州213004 [2]江苏大学附属金坛医院肝胆外科,常州213200

出　　处：《中华转移性肿瘤杂志》2024年第5期435-442,共8页Chinese Journal of Metastatic Cancer

基　　金：常州市卫健委重大项目(ZD202104);常州市应用基础研究计划(CJ20179040);江苏大学医教协同创新基金重点项目(JDY2022018);常州市卫健委科技项目前沿技术(QY202309)。

摘　　要：目的建立术前指标模型对肺腺癌淋巴结转移进行预测,协助外科医生术前辅助判断。方法纳入2017年4月至2023年11月接受肺癌根治性手术的811例肺腺癌患者,手术方式采用普通胸腔镜手术或达芬奇机器人辅助胸腔镜手术。Logistic单因素和多因素分析肺腺癌淋巴结转移的危险因素,使用R软件将多因素分析有意义的因素绘制列线图,校准曲线验证模型的可行性。研究纳入的因素有年龄、性别、吸烟史、肿瘤大小、肿瘤位置、实性成分占比、6种CT征象(分叶征、毛刺征、空泡征、空气支气管征、血管集束征和胸膜牵拉征)、总胆固醇、总甘油三酯、低密度脂蛋白、高密度脂蛋白和体质指数。结果多因素分析有意义并纳入列线图的变量有肿瘤大小(OR=13.66,95%CI为3.78~49.36,P<0.001)、实性成分占比(OR=4.16,95%CI为1.099~15.701,P<0.001)、分叶征(OR=2.51,95%CI为1.036~6.081,P=0.042)和血清总胆固醇含量(OR=4.4695%CI为1.720~11.535,P=0.02)。曲线下面积为0.773,校准曲线显示训练组和验证组有很高的一致性。结论基于构建的列线图的可靠性,临床医师可以评估具有特定术前检查结果的肺腺癌患者淋巴结转移的可能性,辅助对手术方案的选择。Objective To develop a model of preoperative indicators for prediction of lymph node metastasis of lung adenocarcinoma and to assist surgeons in adjunctive judgment before surgery.Methods A total of 811 patients with lung adenocarcinoma who underwent radical lung cancer surgery between April 2017 and November 2023 were included,and the surgery was either general thoracoscopic surgery or da Vinci robotic-assisted thoracoscopic surgery.Logistic uni-and multivariate analysis of risk factors was used to analyze lung adenocarcinoma lymph node metastasis,and R software was used to draw a column graph for the factors that were meaningful in the multifactorial analysis.Calibration curves were used to verify the feasibility of the model.The factors included in this study were age,gender,smoking history,tumor size,tumor location,consolidation tumor ratio,six CT features,lobulation sign,spiculation sign,void sign,air-bronchogram sign,vascular cluster sign,and pleural retraction sign,total cholesterol,total triglycerides,low-density lipoproteins,high-density lipoproteins,and body mass index.Results After statistical analysis,the variables that were significant in the multifactorial analysis and included in the establishment of the nomogram were:tumor size(OR=13.66,95%CI 3.78-49.36,P<0.001),consolidation tumor ratio(OR=4.16,95%CI 1.099-15.701,P<0.001),lobulation sign(OR=2.51,95%CI 1.036-6.081,P=0.042)and serum total cholesterol(OR=4.4695%CI 1.720-11.535,P=0.02).The area under the curve was 0.773,and the calibration curve showed high agreement between the training and validation groups.Conclusion Based on the reliability of the constructed nomogram,surgeons can assess the probability of lymph node metastasis in lung adenocarcinoma patients with specific preoperative characteristics,and then assist to choose surgical options.

关 键 词：肺腺癌 淋巴结转移 预测模型 脂代谢 

分 类 号：R734.2[医药卫生—肿瘤]