Ye Bo, Feng Jian, Pan Xu-feng, Yang Yu, Geng Jun-feng, Cao Ke-jian, Zhao Heng, Hu Ding-zhong
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China. Email:
Zhonghua Wai Ke Za Zhi. 2013 Oct;51(10):904-7.
To analyze the data of patients with clinical stage T1a lung adenocarcinoma and find the predictive factors associated with lymph node metastasis.
From January to June 2012, 271 patients with small nodules of peripheral lung adenocarcinoma were enrolled in the retrospective review. There were 105 male and 112 female patients, with an average age of (61 ± 11)years (range 32-85 years). The data were collected including age, gender, smoking history, carcinoembryonic antigen(CEA), imaging findings, surgical procedure, pleural involvement, symptoms, tumor size, pathological classification, pathologic stage, maximum standardized uptake value(SUVmax) and lymph node metastasis. The predictive factors of lymph node metastasis in clinical factors were detected by univariate and multivariate analysis.
By preoperative thin-section CT, 35 patients were categorized as pure ground-grass opacity(GGO), 11 cases of atypical adenomatous hyperplasia, 24 cases of adenocarcinoma in situ, with no lymph node metastasis. Categorized as mixed ground-glass opacities in 89 patients, 84 patients (94.4%) had no lymph node metastasis, only 5 patients (6.0%) with lymph node metastasis. Categorized as solid nodules in 93 patients, a total of 28 cases (30.1%) had lymph node metastasis. There were statistically significant difference between three groups (χ(2) = 23.41, P < 0.001) . By univariate analysis, we found that the predictive factors of lymph node metastasis were as follows: tumor size > 1 cm (χ(2) = 9.021, P < 0.003) , imaging performance with mixed GGO or solid nodules (χ(2) = 23.41, P < 0.000) , CEA > 5 µg/L (χ(2) = 15.541, P < 0.000) and PET-CT SUVmax > 5 (χ(2) = 0.644, P < 0.000). By multivariate analysis, we found that imaging performance (mixed GGO or solid nodules) was the independent predictor of lymph node metastasis in clinical factors (OR = 166.116, 95%CI:18.161-25.19, P < 0.001) .
Patients of pure GGO generally do not have lymph node metastasis. Tumor diameter > 1 cm, imaging findings with the mixed GGO or solid nodules, carcinoembryonic antigen CEA > 5 µg/L, PET-CT SUVmax > 5 are predictive factors of lymph node metastasis in which imaging is independent predictor.
分析临床分期为T1a期肺腺癌患者的数据，寻找与淋巴结转移相关的预测因素。
回顾性分析2012年1月至6月纳入的271例周围型肺腺癌小结节患者。男性105例，女性112例，平均年龄（61±11）岁（范围32 - 85岁）。收集的数据包括年龄、性别、吸烟史、癌胚抗原（CEA）、影像学表现、手术方式、胸膜受累情况、症状、肿瘤大小、病理分类、病理分期、最大标准化摄取值（SUVmax）及淋巴结转移情况。通过单因素和多因素分析检测临床因素中淋巴结转移的预测因素。
术前薄层CT检查，35例为纯磨玻璃密度影（GGO），11例为非典型腺瘤样增生，24例为原位腺癌，均无淋巴结转移。89例为混合磨玻璃密度影，84例（94.4%）无淋巴结转移，仅5例（6.0%）有淋巴结转移。93例为实性结节，共28例（30.1%）有淋巴结转移。三组间差异有统计学意义（χ(2)=23.41，P<0.001）。单因素分析发现，淋巴结转移的预测因素如下：肿瘤大小>1 cm（χ(2)=9.021，P<0.003）、影像学表现为混合GGO或实性结节（χ(2)=23.41，P<0.000）、CEA>5 μg/L（χ(2)=15.541，P<0.000）及PET-CT SUVmax>5（χ(2)=0.644，P<0.000）。多因素分析发现，影像学表现（混合GGO或实性结节）是临床因素中淋巴结转移的独立预测因素（OR=166.116，95%CI：18.161 - 25.19，P<0.001）。
纯GGO患者一般无淋巴结转移。肿瘤直径>1 cm、影像学表现为混合GGO或实性结节、癌胚抗原CEA>5 μg/L、PET-CT SUVmax>5是淋巴结转移的预测因素，其中影像学是独立预测因素。
