影像表现为亚实性肺结节的90例Ⅰ期肺腺癌患者预后分析

发布时间：2018-05-14 21:29

本文选题：Ⅰ期肺腺癌 + 亚实性肺结节　；参考：《大连医科大学》2015年硕士论文

【摘要】：目的:探讨亚实性结节型Ⅰ期肺腺癌的影像学特点,分析其与良性亚实性结节的差异,为良恶性结节的鉴别诊断提供参考。回顾性分析影像表现为亚实性肺结节Ⅰ期肺腺癌患者的临床特点和预后因素,研究肿瘤中实性成分的比例(C/T比值,consolidation to tumor ratio)与患者预后的关系。方法:收集来自大连医科大学第一附属医院胸外科2008年1月至2010年12月收治的90例后经手术、病理证实为Ⅰ期周围型肺腺癌且CT影像下均表现为亚实性肺结节的患者病例资料。采用的随访策略为,术后第一年每3个月做1次随访,术后第2年每半年做1次随访,术后第3年至随访截止每年做1次随访,随访截止日期为2014年12月。获取患者生存情况和相关临床信息如体格检查、血液生化、肿瘤标记物、胸腹部CT、全身骨扫描检查或者PET-CT检查等结果。另收集76例我院从2012年1月至2014年12月收治的影像学表现为混合性磨玻璃样结节(m GGN),后经手术病理学证实为良性肺结节的患者作为对照,获取患者影像学信息。采用卡方检验对C/T比值、毛刺征、分叶征、胸膜牵拉征、支气管充气征和血管集束征六组数据在良恶性结节的鉴别上是否存在差异进行统计分析。将从90例肺腺癌患者获得的临床和病理资料进行回顾性分析,根据生存情况评估Ⅰ期肺腺癌患者的性别、年龄、手术方式、病理分化程度、肿瘤实性成分占肿瘤最大径的比值(C/T比值)以及各影像学特点等相关临床因素对长期生存的影响。所有数据均采用SPSS20.0统计软件进行统计分析,当P值0.05时被认为具有统计学意义。绘制受试者工作(ROC)曲线,确定最佳截断点(Optimal cut-off point)。Kaplan-Merier法行单因素分析,并绘制生存曲线,Log-rank检验比较组间差异。结果:90例肺腺癌患者中,男性34例(37.8%),女性56例(62.2%);年龄范围53岁-82岁,中位年龄62岁;行肺叶切除术患者72例(80.0%),肺局部切除术患者13例(14.4%),其他切除患者5例(5.0%);病理报告呈高分化病例65例(72.2%),中分化14例(15.6%),低分化11例(12.2%);影像学表现为分叶征67例(74.4%),毛刺征70例(77.8%),胸膜牵拉征21例(23.3%),支气管充气征26例(28.9%),血管集束征16例(17.8%)。受试者工作特征(ROC)曲线显示对于肺腺癌恶性结节和良性结节针对C/T比值的区分,其最大曲线下面积(AUC,area under the curve)为0.73,95%置信区间(CI,Confidence interval)为0.69-0.80,表明此实验具有一定准确性,最佳截断点(Optimal cut-off point)约为0.50。良性组和恶性组在C/T比值、分叶征、毛刺征、支气管充气征(P0.05)等方面差异显著,具有统计学意义。Kaplan-Merier单因素生存分析显示,C/T比值是影响Ⅰ期肺腺癌预后的因素。其中C/T比值0.50的患者五年生存率明显比0.50的患者的生存率低,分别为40.1%和84.3%,P0.05。结论:C/T比值大小、分叶征、毛刺征、支气管充气征是亚实性型良性肺结节和肺腺癌结节的鉴别要点。C/T比值是影像表现为亚实性肺结节的Ⅰ期肺腺癌患者预后危险因素之一。
[Abstract]:Objective: To investigate the imaging features of phase I lung adenocarcinoma of subsolid nodular type, analyze the difference between the benign nodule and benign nodule, and provide reference for the differential diagnosis of benign and malignant nodules. The clinical and prognostic factors of the patients with stage I lung adenocarcinoma of subsolid pulmonary nodules were analyzed retrospectively, and the ratio of the solid components in the tumor (C/T ratio) was studied. Value, the relationship between consolidation to tumor ratio) and the prognosis of patients. Methods: 90 cases from the Department of thoracic surgery, the First Affiliated Hospital of Dalian Medical University, from January 2008 to December 2010, were collected and treated by surgery. The case data of patients with stage I peripheral pulmonary adenocarcinoma confirmed by pathology with CT image as subsolid pulmonary nodules were collected. The follow-up policy was adopted. For the first year after the operation, 1 follow-up was done every 3 months, 1 follow-up second years after second years, third years after third to 1 follow-up, and the follow-up deadline was December 2014. The patient's survival and related clinical information such as physical examination, blood biochemistry, tumor markers, thoracic and abdominal CT, whole body bone scan examination, or PET-CT The imaging findings of 76 cases in our hospital from January 2012 to December 2014 were collected as mixed grind glass like nodules (m GGN). The imaging information of patients with benign pulmonary nodules confirmed by surgery and pathology was taken as control. The ratio of C/T, burr sign, lobulated sign, pleural stretch sign, bronchus and bronchi were used. Six groups of data on the differentiation of benign and malignant nodules were statistically analyzed. The clinical and pathological data obtained from 90 cases of lung adenocarcinoma were retrospectively analyzed. The sex, age, hand mode, pathological differentiation, and solid composition of the patients with stage I lung adenocarcinoma were evaluated according to the survival conditions. The effect of the ratio of the maximum diameter of the tumor (C/T ratio) and the various imaging characteristics on the long-term survival. All data were statistically analyzed by SPSS20.0 software. When the value of P was 0.05, the statistical significance was considered. The ROC curve was drawn and the best truncation point (Optimal cut-off point).Kaplan-Meri was determined. A single factor analysis was performed by Er, and the survival curve was plotted. Results: among the 90 cases of lung adenocarcinoma, 34 (37.8%) and 56 women (62.2%) were male, 53 years old and 62 years old, 72 (80%), 13 (14.4%) patients with lobectomy, 5 (5%) in other excised patients, and pathology, and pathology. The report showed 65 cases of highly differentiated cases (72.2%), 14 cases of middle differentiation (15.6%), 11 cases of low differentiation (12.2%), 67 cases of lobulation syndrome (74.4%), 70 cases of burr sign (77.8%), 21 cases of pleural stretch sign (23.3%), bronchoalveolar sign 26 cases (28.9%), and vascular bundle sign (ROC) curve showed malignant nodules of lung adenocarcinoma and the malignant nodules of lung adenocarcinoma. The benign nodule was distinguished from the C/T ratio, and the area under the maximum curve (AUC, area under the curve) was 0.73,95% confidence interval (CI, Confidence interval) as 0.69-0.80, indicating that the experiment was accurate and the best truncation point was about the ratio of benign and malignant groups, lobulation sign, burr sign, bronchial filling. There were significant differences in gas sign (P0.05). The statistical significance of.Kaplan-Merier single factor survival analysis showed that the C/T ratio was a prognostic factor for stage I lung adenocarcinoma. The five year survival rate of patients with C/T ratio 0.50 was significantly lower than that of 0.50 patients, 40.1% and 84.3% respectively, P0.05. conclusion: the C/T ratio, lobular sign, Mao Cizheng The identification of bronchoalveolar sign is a subsolid benign pulmonary nodule and a lung adenocarcinoma nodule. The.C/T ratio is one of the risk factors for the prognosis of patients with stage I lung adenocarcinoma with subsolid pulmonary nodules.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

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