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中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (04) : 213 -218. doi: 10.3877/cma.j.issn.2095-8773.2018.04.03

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论著

薄层CT扫描在区分多发性肺癌和肺磨玻璃结节成分及预后评估中的价值
宣煜龙1,(), 史敏科1   
  1. 1. 210008 南京大学医学院附属南京鼓楼医院心胸外科
  • 收稿日期:2018-08-15 出版日期:2018-11-28
  • 通信作者: 宣煜龙

The impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity

Yulong Xuan1,(), Minke Shi1   

  1. 1. Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China
  • Received:2018-08-15 Published:2018-11-28
  • Corresponding author: Yulong Xuan
  • About author:
    Corresponding author: Xuan Yulong, Email:
引用本文:

宣煜龙, 史敏科. 薄层CT扫描在区分多发性肺癌和肺磨玻璃结节成分及预后评估中的价值[J/OL]. 中华胸部外科电子杂志, 2018, 05(04): 213-218.

Yulong Xuan, Minke Shi. The impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(04): 213-218.

目的

通过薄层CT扫描区分多发性肺癌和肺磨玻璃结节(GGO)成分,并评估其预后影响因素。

方法

回顾性分析3 254例Ⅰ期肺癌行手术切除患者,其中312例(9.6%)为多发性肺癌,所有患者根据GGO大小、薄层CT上的肿瘤实性成分比值(CTR)分为磨玻璃成分为主(GD)(0 ≤CTR < 0.5)、实性成分为主(SD)(0.5 ≤CTR < 1.0)、纯实性(PS)(CTR =1.0)。根据影像学结果将多发性肺癌患者分为6组:GD+GD组、GD+SD组、GD+PS组、SD+SD组、SD+PS组和PS+PS组。采用Cox比例风险模型对比临床Ⅰ期肺癌患者的预后情况。

结果

312例多发性肺癌患者中,251例(80.4%)切除了2个以上肿瘤同时病理诊断为多发性肺部肿瘤。其中GD+ GD患者90例(28.8%),GD +SD患者70例(22.4%),GD+ PS患者66例(21.2%),SD +SD患者16例(5.1%), SD +PS患者27例(8.7%),PS +PS患者43例(13.8%)。多变量分析显示,PS +PS是影响预后的独立危险因素(P<0.001)。整体生存率分别为GD+GD组96.7%,GD +SD组98.6%,GD+PS组84.8%,SD +SD组93.8%,SD+ PS组77.8%,PS +PS组41.9%。PS +PS组与其他组相比差异均有统计学意义(P<0.05)。此外,剩余2 942例Ⅰ期肺癌患者的整体生存率为78.2%,与PS+PS组相比差异也有统计学意义(P<0.001),而其他组与剩余患者相比预后类似甚至更好。

结论

在多发性肺癌患者中,PS +PS组患者生存率更低,这可能促进T分期更新,多发肺癌患者GGO影像学形态及其类型对预后评估极其重要。

Objective

The purpose of this study is to evaluate the impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity.

Methods

We reviewed the clinical data of 3254 surgically resected c-stage I lung cancer patients, 312 (9.6%)with multiple lung tumors. All patients were classified into 3 groups based on the extent of ground glass opacity (GGO) and consolidation tumor ratio (CTR), including GGO-dominant (GD)(0 ≤CTR < 0.5), solid-dominant (SD) (0.5 ≤CTR < 1.0) , and pure-solid (PS) (CTR =1.0). Patients with multiple lung tumors were divided into 6 groups based on imaging findings, including GD+ GD group, GD+ SD group, GD+ PS group, SD+ SD group, SD+ PS group and PS+ PS group , and their prognoses were compared with that of c-stage I lung cancer using Cox’s proportional hazard model.

Results

Among all, 251(80.4%) have surgically resected more than two tumors and pathologically determined as multiple lung cancers patients . Among 312 patients , 90 in GD+ GD group (28.8%), 70 in GD + SD group(22.4%), 66 in GD+ PS group(21.2%), 16 in SD + SD group(5.1%), 27 in SD+ PS group(8.7%), and 43 in PS + PS group(13.8%). Based on the results of multivariate analyses, PS+ PS revealed the independent risk factors for prognosis impact(P<0.001). The overall survival rate (OS) was 96.7% in group GD+ GD, 98.6% in group GD + SD, 84.8% in group GD+ PS , 93.8% in group SD+ SD , 77.8% in group SD+ PS , 41.9% in group PS + PS , which showing a significant difference between PS+ PS group and the other groups (P<0.05).

Conclusions

Among all patients with multiple lung cancers, patients in PS+ PS group have lower survival rate, which would contribute to the upstaging of T descriptors. The imaging findings of GGO and its classifications are extremely important to prognosis evaluation.

表1 312例多发性肺癌患者的病理学特点[n(%)]
病理学特点 GD+GD组(n=90) GD+SD组( n=70) GD+PS组( n=66) SD+SD组( n=16) SD+PS组( n=27) PS+PS组( n=43) P
p-N(N1/N2) 0(0)/0(0) 0(0)/4(5.7) 6(9.1)(0)/6(9.1) 0(0)/1(6.3) 5(18.5)/5(18.5) 6(14)/10(23.3) <0.001
病理分期 ? ? ? ? ? ? ?
? ⅠA/ⅠB期 89(98.9)/1(1.1) 53(75.5)/13(18.6) 48(72.7)/8(12.1) 7(43.8)/6(37.5) 12(44.4)/4(14.8) 8(18.6)/10(23.3) <0.001
? ⅡA/ⅡB期 0(0)/0(0) 0(0)/1(1.4) 5(7.6)/2(3.0) 1(6.3)/1(6.3) 5(18.5)/2(7.4) 9(20.9)/3(7) ?
? ⅢA/ⅢB期 0(0)/0(0) 3(4.3)/0 3(4.5)/0(0) 1(6.3)/0(0) 4(14.8)/0(0) 8(18.6)/0(0) ?
? Ⅳ期 0(0) 0(0) 0(0) 0(0) 0(0) 5(11.6) ?
组织学表现 ? ? ? ? ? ? ?
? 多原发性肺癌 82(91.1) 39(55.7) 45(68.2) 16(100) 26(96.3) 34(79.1) <0.001
? 肺内转移 0(0) 0(0) 0(0) 0(0) 1(3.7) 9(20(0).9) ?
组织学类型 ? ? ? ? ? ? ?
? 腺癌 7(7.8) 31(44.3) 22(33.3) 0(0) 0(0) 0(0) <0.001
? 多发腺癌 83(92.2) 39(45.7) 39(59.1) 16(100) 26(96.3) 22(51.2) ?
? 鳞癌 0(0) 0(0) 1(1.5) 0(0) 0(0) 0(0) ?
? 多发鳞癌 0(0) 0(0) 0(0) 0(0) 0(0) 6(14) ?
? 腺癌+鳞癌 0(0) 0(0) 2(3.0) 0(0) 1(3.7) 11(25.6) ?
? 腺癌+腺样鳞形细胞癌 0(0) 0(0) 2(3.0) 0(0) 0(0) 2(7.4) ?
? 腺癌+大细胞神经内分泌癌 0(0) 0(0) 0(0) 0(0) 0(0) 2(7.4) ?
EGFR突变 23(25.6) 31(44.3) 28(42.4) 8(50) 16(59.3) 14(32.6) 0.043
侵犯淋巴管 1(1.1) 11(15.7) 22(33.3) 5(31.3) 9(33.3) 18(41.9) <0.001
侵犯血管 1(1.1) 6(8.6) 20(30.3) 3(18.8) 8(29.6) 24(55.8) <0.001
新辅助化疗 10(11.1) 18(25.7) 16(24.2) 1(6.3) 8(29.6) 16(37.2) 0.025
表2 312例多发性肺癌患者单变量与多变量整体生存率分析
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