早期肺腺癌组织学亚型与高分辨率计算机断层扫描特征的相关性
Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma.
作者信息
Miao Yingying, Zhang Jianya, Zou Jiawei, Zhu Qingqing, Lv Tangfeng, Song Yong
机构信息
Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, China;; Nanjing University Institute of Respiratory Medicine, Nanjing 210002, China.
出版信息
Transl Lung Cancer Res. 2017 Feb;6(1):14-22. doi: 10.21037/tlcr.2017.02.06.
BACKGROUND
Uncertainty remains on the association between image characteristics of the nodules in computed tomography (CT) scans and lung adenocarcinoma histopathologic subtypes. We aimed to estimate the correlation between preoperative high resolution computed tomography (HRCT) scan and postoperative histopathology of stage IA lung adenocarcinoma in East Asian Chinese population.
METHODS
We retrospectively reviewed the clinical records and HRCT images of 190 patients (106 female and 84 male) with resected, preoperatively untreated stage IA adenocarcinomas. The relationship between image characteristics of nodules at preoperative HRCT and their histological subtypes after resection were analyzed. The one-way ANOVA, chi-square test and logistic regression were used for analysis.
RESULTS
In 190 patients with stage IA lung adenocarcinoma, median tumor diameter was significantly lower in lepidic predominant invasive adenocarcinoma (LPA) (15.96±6.95 mm). Univariate analysis revealed that ground-glass opacity (GGO) proportion (P<0.001), margin (P<0.001), border definition (P=0.015), pleural retraction (P<0.001) and enhancement (P<0.001) had statistically significant differences in four histological subtypes. The multivariate analysis referenced for lepidic group which indicated that GGO proportion and pleural retraction were independent associated with acinar group (RR=4.221, 95% CI: 1.770-10.066, P=0.001; RR=0.380, 95% CI: 0.158-0.916, P=0.031, respectively). Male and whose nodule margin with spiculation or lobulation were prone to papillary predominant invasive adenocarcinoma (PPA) (RR=0.288, 95% CI: 0.090-0.920, P=0.036; RR=0.250, 95% CI: 0.070-0.887, P=0.032, respectively). GGO proportion and nodule margin were independent related factors in solid predominant invasive adenocarcinoma (SPA) (RR=13.338, 95% CI: 2.974-59.811, P=0.001; RR=0.097, 95% CI: 0.016-0.606, P=0.013, respectively).
CONCLUSIONS
Nodules with spiculation or lobulation and less GGO proportion are determinants of histological subtypes with poor prognosis in stage IA lung adenocarcinoma patients according to the 2011 histologic IASLC/ATS/ERS classification.
背景
计算机断层扫描（CT）中结节的影像特征与肺腺癌组织病理学亚型之间的关联仍不明确。我们旨在评估东亚中国人群中术前高分辨率计算机断层扫描（HRCT）与IA期肺腺癌术后组织病理学之间的相关性。
方法
我们回顾性分析了190例（106例女性和84例男性）接受手术切除且术前未接受治疗的IA期腺癌患者的临床记录和HRCT图像。分析术前HRCT上结节的影像特征与其切除后的组织学亚型之间的关系。采用单因素方差分析、卡方检验和逻辑回归进行分析。
结果
在190例IA期肺腺癌患者中，鳞屑状为主的浸润性腺癌（LPA）的肿瘤中位直径显著更低（15.96±6.95mm）。单因素分析显示，磨玻璃密度影（GGO）比例（P<0.001）、边缘（P<0.001）、边界清晰度（P=0.015）、胸膜凹陷（P<0.001）和强化（P<0.001）在四种组织学亚型中有统计学显著差异。以鳞屑状组为参照的多因素分析表明，GGO比例和胸膜凹陷分别与腺泡状组独立相关（RR=4.221，95%CI：1.770-10.066，P=0.001；RR=0.380，95%CI：0.158-0.916，P=0.031）。男性以及结节边缘有毛刺或分叶的患者更容易发生乳头状为主的浸润性腺癌（PPA）（RR=0.288，95%CI：0.090-0.920，P=0.036；RR=0.250，95%CI：0.070-0.887，P=0.032）。GGO比例和结节边缘是实性为主的浸润性腺癌（SPA）的独立相关因素（RR=13.338，95%CI：2.974-59.811，P=0.001；RR=0.097，95%CI：0.016-0.606，P=0.013）。
结论
根据2011年组织学国际肺癌研究协会/美国胸科学会/欧洲呼吸学会分类，有毛刺或分叶且GGO比例较低的结节是IA期肺腺癌患者预后较差的组织学亚型的决定因素。
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