肺癌治疗后腹部CT的附加值。

Added value of abdominal CT after treatment of lung cancer.

作者信息

Zhu Yunjing, Liu Jing, Nie Kai, Chen Qunhui, Yu Lingming, Zhang Yuxuan, Li Shaojie, Sun Yanbing, Ni Qiming, Tao Guangyu, Parrington John, Zhu Lin, Yu Hong

机构信息

Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Radiology, Zhabei Central Hospital, Jing'an District, Shanghai, China.

出版信息

Quant Imaging Med Surg. 2025 Aug 1;15(8):6787-6800. doi: 10.21037/qims-2025-142. Epub 2025 Jul 30.

DOI:10.21037/qims-2025-142

PMID:40785936

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12332602/

Abstract

BACKGROUND

Lung cancer exhibits poor survival outcomes, particularly in cases where distant metastases are identified at the time of diagnosis or following treatment. In instances where there is a heightened risk of distant metastasis, customized postoperative abdominal computed tomography (CT) scans may be beneficial in the early identification of metastatic lung cancer, which holds promise for enhancing survival rates by facilitating prompt initiation of curative interventions. This study aimed to evaluate the effectiveness of additional abdominal CT scans in identifying extrapulmonary and abdominal metastases in lung cancer patients' post-treatment.

METHODS

A retrospective analysis was conducted on patients diagnosed with lung cancer between January 2015 and December 2017 who underwent at least one follow-up abdominal CT scan after treatment. Cumulative rates of extrapulmonary and isolated abdominal metastasis were analyzed using Kaplan-Meier method and compared with log-rank tests. Cox proportional hazard models were performed to identify risk factors for extrapulmonary and isolated abdominal metastases. The radiation dose for each abdominal CT scan was recorded in volume CT dose index (CTDI) and dose-length product (DLP), and effective dose (ED) was calculated.

RESULTS

A cohort of 396 patients (mean age, 59±8 years; 239 men) was incorporated in the study. The cumulative incidence rates at 3 years of extrapulmonary metastasis and isolated abdominal metastasis were 28.3% and 11.4%, respectively. Significant risk factors for extrapulmonary metastasis included histological subtype, T stage, lymph node metastasis, and size of the largest tumor. Statistical significance was observed in histological subtype, T stage, lymph node metastasis, mutation, squamous cell carcinoma antigen, and size of the largest tumor in cases of isolated abdominal metastasis. The EDs of radiation exposure in non-contrast and contrast-enhanced abdominal CT scanning were 7.2±3.5 and 18.2±6.9 mSv, respectively.

CONCLUSIONS

The incorporation of abdominal CT scans into follow-up protocols may be a valuable strategy for the early detection and management of distal metastasis in lung cancer patients with risk factors.

摘要

背景

肺癌患者的生存预后较差，尤其是在诊断时或治疗后发现远处转移的情况下。在远处转移风险较高的情况下，定制的术后腹部计算机断层扫描（CT）可能有助于早期发现转移性肺癌，通过及时启动根治性干预措施有望提高生存率。本研究旨在评估额外的腹部CT扫描在肺癌患者治疗后识别肺外和腹部转移灶的有效性。

方法

对2015年1月至2017年12月期间诊断为肺癌且治疗后至少接受过一次腹部CT随访扫描的患者进行回顾性分析。采用Kaplan-Meier法分析肺外和孤立性腹部转移的累积发生率，并通过对数秩检验进行比较。采用Cox比例风险模型确定肺外和孤立性腹部转移的危险因素。记录每次腹部CT扫描的辐射剂量，以容积CT剂量指数（CTDI）和剂量长度乘积（DLP）表示，并计算有效剂量（ED）。

结果

本研究纳入了396例患者（平均年龄59±8岁；男性239例）。3年时肺外转移和孤立性腹部转移的累积发生率分别为28.3%和11.4%。肺外转移的显著危险因素包括组织学亚型、T分期、淋巴结转移和最大肿瘤大小。在孤立性腹部转移病例中，组织学亚型、T分期、淋巴结转移、突变、鳞状细胞癌抗原和最大肿瘤大小具有统计学意义。非增强和增强腹部CT扫描的辐射暴露有效剂量分别为7.2±3.5和18.2±6.9 mSv。