目的 探讨浸润性肺腺癌淋巴结转移与临床病理特征之间的相关性,并构建列线图预测浸润性肺腺癌淋巴结转移风险.方法 回顾性分析1589例原发浸润性肺腺癌患者的相关临床病理资料,其中男性737例(46.4％),女性852例(53.6％),中位年龄61岁.分析年龄、性别、吸烟史、病理亚型、病理成分、肿瘤位置、肿瘤直径、胸膜侵犯、脉管侵犯等因素与淋巴结转移的相关性.采用单因素及多因素Logistic回归分析方法筛选肺腺癌患者发生淋巴结转移的独立危险因素并构建列线图模型,采用受试者工作特征(ROC)曲线下面积(AUC)及校准曲线评价模型预测效能及校准度.结果 366例(23.0％)患者术后病理证实有淋巴结转移.淋巴结转移组较无淋巴结转移组患者年龄更小、肿瘤直径更大(P＜0.05);淋巴结转移组中男性、脏层胸膜侵犯、脉管侵犯及微乳头/实体亚型的占比较无淋巴结转移组更高,差异有统计学意义(P＜0.05).多因素Lo-gistic 回归分析显示,年龄＞60岁(OR=0.603,95％CI:0.459～0.793,P＜0.001)是淋巴结转移的独立保护因素;肿瘤直径(＞3 cm 且≤5 cm:OR=1.718,95％CI:1.263～2.336,P=0.001;＞5 cm:OR=2.332,95％CI:1.331～4.086,P=0.003)、有微乳头/实体成分(OR=3.978,95％CI:2.956～5.352,P＜0.001)、脏层胸膜侵犯(OR=3.376,95％CI:2.410～4.728,P＜0.001)、脉管侵犯(OR=6.949,95％CI:4.162～11.602,P＜0.001)是淋巴结转移的独立危险因素.基于以上临床病理特征构建列线图,ROC曲线显示列线图模型预测淋巴结转移的效能较好(AUC=0.806,95％CI:0.779～0.833).结论 基于临床病理特征构建的列线图可以较好地预测浸润性肺腺癌淋巴结转移的风险.
Analysis of clinicopathological factors and establishment of prediction model for lymph node metastasis in invasive lung adenocarcinoma
Objective To explore the correlation between lymph node metastasis and clinicopathological features of invasive lung adenocarcinoma,and establish a nomogram to predict the probability of lymph node metastasis of invasive lung adenocarcinoma.Methods The clinicopathological data of 1589 cases of primary invasive lung adenocarcinoma were retrospectively analyzed,including 737 males(46.4％)and 852 females(53.6％),with an median age of 61 years.The correlation of age,gender,smoking history,pathological subtypes,pathological components,tumor location,tumor diameter,visceral pleural invasion(VPI)and lymphovascular invasion(LVI)with lymph node metastasis was analyzed.The independent risk factors of lymph node metastasis were determined by univariate and multivariate Logistic regression and a nomogram model was established.The predictive efficiency and calibration degree of the model were evaluated by the receiver operating characteristic(ROC)and calibration curve.Results The total lymph node metastasis rate was 23.0％(366/1589).Patients with lymph node metastasis were younger and had larger tumor diameters compared to those without lymph node metastasis(P＜0.05).The proportion of males,VPI,LVI,and micropapillary/solid subtypes in the lymph node metastasis group was higher than that in the group without lymph node metastasis,and the difference was statistically significant(P＜0.05).Multivariate analysis showed that age＞60 years(OR=0.603,95％CI:0.459-0.793,P＜0.001)was an independent protective factor for lymph node metastasis,and tumor diameter(＞3 cm and ≤ 5 cm:OR=1.718,95％CI:1.263-2.336,P=0.001;＞5 cm:OR=2.332,95％CI:1.331-4.086,P=0.003),micropapillary/solid component(OR=3.978,95％CI:2.956-5.352,P＜0.001),VPI(OR=3.376,95％CI:2.410-4.728,P＜0.001)and LVI(OR=6.949,95％CI:4.162-11.602,P＜0.001)were independent risk factors for lymph node metastasis.ROC curve showed that the nomogram established based on the above clinicopathological features had a good predictive performance for lymph node metastasis(AUC=0.806,95％CI:0.779-0.833).Conclusion The nomogram based on clinicopathological features can better predict the risk of lymph node metastasis in invasive lung adenocarcinoma.
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