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中华胸部外科电子杂志

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

所属专题： 专题评论； 文献；

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:
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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]. 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]. 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。

关键词: 多发性肺癌, 磨玻璃结节, 影像学表现, 预后
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.

Key words: Multiple lung cancers, Ground glass opacity, Imaging findings, Prognosis
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值
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
因素 单变量 多变量
HR(95% CI) P值 HR(95% CI) P值
慢性阻塞性肺部疾病 0.938(0.334～2.397) 0.905 ? ?
血癌胚抗原数值(ng/ml) 1.058(1.003～1.085) 0.003 1.016(0.916～1.078) 0.295
最大肿瘤直径(mm) 1.086(1.043～1.112) <0.001 1.025(0.957～1.078) 0.183
影像学分类(PS ＋ PS) 11.34(5.127～22.34) <0.001 6.324(0.095～0.579) 0.003
行肺叶切除术 14.12(1.835～97.34) 0.015 5.572(0.734～45.72) 0.095
腺癌 0.428(0.213～1.127) 0.083 ? ?
累及淋巴结 0.144(0.068～0.375) <0.001 0.397(0.146～0.994) 0.047
累及淋巴管 0.239(0.115～0.512) <0.001 0.975(0.384～2.495) 0.968
新辅助化疗 0.548(0.264～1.170) 1.127 ? ?
1
Girard N, Deshpande C, Lau C, et al. Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases[J]. Am J Surg Pathol, 2009, 33(12):1752-1764.
2
Martini N, Melamed MR. Multiple primary lung cancers[J]. J Thorac Cardiovasc Surg，1975，70(4):606-612.
3
Takamochi K, Oh S, Matsuoka J, et al. Clonality status of multifocal lung adenocarcinomas based on the mutation patterns of EGFR and K-ras[J]. Lung Cancer，2012，75(3):313-320.
4
Wan L, Pantel K, Kang Y. Tumor metastasis: moving new biological insights intothe clinic[J]．Nat Med，2013，19(11):1450-1464.
5
Hattori A, Suzuki K, Matsunaga T, et al. Prognostic significance of the standardized uptake value on positron emission tomography in patients with multiple clinical-N0 lung cancers[J]．Thorac Cardiovasc Surg, 2015，63(7):597-603.
6
Detterbeck FC, Nicholson AG, Franklin WA, et al.The IASLC Lung Cancer Staging Project: summary of proposals for revisions of the classification of lung cancers with multiple pulmonary sites of involvement in the forthcoming eighth edition of the TNM classification[J]．J Thorac Oncol，2016，11(5):639-650.
7
Detterbeck FC, Franklin WA, Nicholson AG, et al.The IASLC Lung Cancer Staging Project: background data and proposed criteria to distinguish separate primary lung cancers from metastatic foci in patients with two lung tumors in the forthcoming eighth edition of the TNM classification for lung cancer[J]．J Thorac Oncol，2016，11(5):651-665.
8
Suzuki K, Koike T, Asakawa T, et al.A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201)[J]．J Thorac Oncol，2011，6(4):751-756.
9
Hattori A, Matsunaga T, Takamochi K, et al. Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should Be applied exclusively to solid lung cancer[J]. Ann Thorac Surg，2016，102(2):407-415.
10
Hattori A, Matsunaga T, Takamochi K, et al. Surgical management of multifocal ground-glass opacities of the lung: correlation of clinicopathologic and radiologic findings[J]．Thorac Cardiovasc Surg，2017，65(2):142-149.
11
Hattori A, Matsunaga T, Takamochi K, et al.Oncological characteristics of radiological invasive adenocarcinoma with additional ground-glass nodules on initial thin-section computed tomography: comparison with solitary invasive adenocarcinoma[J]．J Thorac Oncol, 2016 ，11(5):729-736.
12
Travis WD, Asamura H, Bankier AA, et al.The IASLC Lung Cancer Staging Project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer[J]．J Thorac Oncol，2016，11(8):1204-1223.
13
Vazquez M, Carter D, Brambilla E, et al. Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: histopathologic features and their prognostic implications[J]. Lung Cancer, 2009，64(2):148-154.
14
Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours[J]. J Thorac Oncol，2007，2(8):706-714.
15
Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤ 1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study[J]. J Clin Oncol，2016，34(26):3175-3182.
16
Hattori A, Suzuki K, Matsunaga T, et al. Is limited resection appropriate for radiologically solid tumors in small lung cancers？[J] Ann Thorac Surg，2012，94(1):212-215.
17
Gu B, Burt BM, Merritt RE, et al.A dominant adenocarcinoma with multifocal ground glass lesions does not behave as advanced disease[J]. Ann Thorac Surg，2013，96(2):411-418.
18
Shimada Y, Saji H, Otani K, et al.Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions[J]. Lung Cancer，2015，88(2):174-180.
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