Liu Zhan, Feng Hongxiang, Zhang Zhenrong, Sun Hongliang, Liu Deruo
1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China.
J Thorac Dis. 2020 Jun;12(6):3148-3156. doi: 10.21037/jtd-20-426.
With the emerging radiological techniques and the increasing incidence of adenocarcinoma, the composition and structure of cavitary lung cancer have been significantly changed. The aim of the study was to demonstrate clinicopathological characteristics of solitary cavitary lung cancer which was ≤3 cm.
A case-control study was designed through retrospective data analysis of clinicopathological data of 946 cases with solitary lung cancer smaller than 3 cm. Univariable and multivariable analysis were used to identify the risk factors of cavitation.
Cavitary lung cancer occurred more frequently in patients who were elderly (P=0.044), male (P=0.004), who had a smoking history (P=0.018), higher carcinoembryonic antigen (CEA) level (P<0.001), peripheral lesions (P=0.017), solid nodules (P<0.001), spiculation (P=0.003), vascular convergence (P<0.001), air bronchogram (P=0.004), larger tumor size (P<0.001), advanced T stage (P<0.001), lymph node metastasis (P=0.028) and advanced pTNM stage (P=0.004). In addition, cavitary lung cancer was more common in papillary predominant tumors (P=0.017), while noncavitary lung cancer occurred more frequently in AIS/MIA (P=0.002) and lepidic predominant tumors (P<0.001). It was confirmed that cavitation was significantly associated with elderly (P=0.013), male (P=0.003), larger maximum tumor diameter (P<0.001), solid nodules (P<0.001), larger pT size (P=0.016) and advanced pN stage (P=0.036) in multivariable analysis. ROC curves showed that the AUV was greater in maximum tumor diameter than in pT size predicting cavitation (0.71 0.66). A cut off value of 20.9 mm showed a discriminatory power of cavitation with a sensitivity of 68.7% and a specificity of 71.2%.
Comparing with noncavitary lung cancer, cavitary lung cancer smaller than 3 cm may have worse prognostic clinical, radiological and pathological characteristics. Especially, cavitary lung cancer present as more solid nodules on CT images and present with more invasive on pathological findings.
随着放射技术的不断涌现以及腺癌发病率的上升，空洞型肺癌的组成和结构发生了显著变化。本研究的目的是阐述直径≤3 cm的孤立性空洞型肺癌的临床病理特征。
通过对946例直径小于3 cm的孤立性肺癌患者的临床病理数据进行回顾性数据分析，设计了一项病例对照研究。采用单因素和多因素分析来确定空洞形成的危险因素。
空洞型肺癌在老年患者（P=0.044）、男性（P=0.004）、有吸烟史（P=0.018）、癌胚抗原（CEA）水平较高（P<0.001）、周围型病变（P=0.017）、实性结节（P<0.001）、毛刺征（P=0.003）、血管集束征（P<0.001）、空气支气管征（P=0.004）、肿瘤直径较大（P<0.001）、T分期较晚（P<0.001）、淋巴结转移（P=0.028）及pTNM分期较晚（P=0.004）的患者中更常见。此外，空洞型肺癌在以乳头状为主的肿瘤中更常见（P=0.017），而非空洞型肺癌在原位腺癌/微浸润腺癌（P=0.002）和以鳞屑状为主的肿瘤中更常见（P<0.001）。多因素分析证实，空洞形成与老年（P=0.013）、男性（P=0.003）、最大肿瘤直径较大（P<0.001）、实性结节（P<0.001）、pT尺寸较大（P=0.016）及pN分期较晚（P=0.036）显著相关。ROC曲线显示，预测空洞形成时，最大肿瘤直径的曲线下面积大于pT尺寸（0.71对0.66）。截断值为20.9 mm时，显示出对空洞形成的判别能力，敏感性为68.7%，特异性为71.2%。
与非空洞型肺癌相比，直径小于3 cm的空洞型肺癌可能具有更差的预后临床、放射学和病理学特征。特别是，空洞型肺癌在CT图像上表现为更多实性结节，在病理检查中表现出更强的侵袭性。
