摘要
目的 探讨胸部薄层CT形态学参数对结节样肺腺癌脏层胸膜浸润(VPI)的诊断价值.方法 选取术前接受胸部薄层CT扫描并进行肺癌根治术的202例肺腺癌患者,根据病理结果分为VPI组(n=71)与非VPI组(n=131).分析患者的临床资料、病理内容及影像学特征,应用SPSS 25.0软件进行统计分析.结果 在单变量分析中,吸烟史、癌胚抗原(CEA)、病理类型、Ki-67、分化程度、结节性质、病灶最大长径、病灶最大短径、平均CT值、毛刺征、结节与胸膜关系、病灶距邻近胸膜最短距离(DLP)、病灶与胸膜接触直径和胸膜接触比在VPI组和非VPI组间有统计学差异.多因素Logistic回归分析显示,结节与胸膜关系第4型(OR=30.071,95％CI:3.146～287.459)、胸膜接触比(OR=9.584,95％CI:1.152～79.749)、CEA 异常(OR=2.989,95％CI:1.090～8.197)、分化程度(OR=13.230,95％CI:3.239～54.036)是诊断结节样肺腺癌VPI的独立影响因素(P＜0.05);受试者工作特征(ROC)曲线示胸膜接触比最佳截断点为0.029167,曲线下面积(AUC)为0.703(95％CI:0.625～0.782),敏感度为63.4％,特异度为75.6％.结论 结节样肺腺癌患者VPI的预测指标为结节与胸膜关系第4型、胸膜接触比、CEA异常和分化不良.
Abstract
Objective To investigate the diagnostic value of morphological parameters of thin-layer CT of the chest for visceral pleural invasion(VPI)of nodular lung adenocarcinoma.Methods 202 patients with lung adenocarcinoma who underwent preoperative thin-layer CT scanning of the chest and radical lung cancer surgery were selected and divided into the VPI group(n=71)and the non-VPI group(n=131)according to pathological results.The clinical data,pathological contents and imaging characteristics of the patients were analysed,and SPSS 25.0 software was applied for statistical analy-sis.Results In univariate analysis,smoking history,CEA,pathological type,Ki-67,degree of differentiation,nature of the nodule,maximum longitudinal diameter of the lesion,maximum shortitudinal diameter of the lesion,mean CT value,burr sign,relationship between the nodule and the pleura,shortest distance of the lesion from the neighbouring pleura,diameter of the contact between the lesion and pleura,and the pleural contact ratio showed statistically significant differences between the VPI and non-VPI groups.Multifactorial Logistic regression analysis showed nodal-to-pleural relationship type 4(OR=30.071,95％CI:3.146-287.459),pleural contact ratio(OR=9.584,95％CI:1.152-79.749),and CEA abnormality(OR=2.989,95％CI:1.090-8.197),degree of differentiation(OR=13.230,95％CI:3.239-54.036)were inde-pendent influencing factors for the diagnosis of nodular lung adenocarcinoma VPI(P＜0.05);the ROC curve showed that the optimal cut-off point of pleural contact ratio was 0.029167,with an AUC of 0.703(95％CI:0.625-0.782),a sensi-tivity of 63.4％and a specificity was 75.6％.Conclusion Predictors of VPI in patients with nodular lung adenocarcino-ma were nodal-to-pleural relationship type 4,pleural contact ratio,CEA abnormality and poor differentiation.
基金项目
海南省重点研发项目(ZDYF2021SHFZ244)
维普
万方数据