高分辨CT联合Ki-67表达预测低分化浸润性非黏液肺腺癌的临床应用

Clinical application of high-resolution CT combined with Ki-67 expression in predicting poorly differentiated invasive non-mucinous lung adenocarcinoma

目的探讨高分辨率CT(HRCT)影像特征结合Ki-67表达水平对低分化浸润性非黏液腺癌的预测价值。方法回顾性分析2015-07至2023-06在中部战区总医院及联勤保障部队第991医院诊治的197例浸润性非黏液肺腺癌患者临床资料,根据病理结果分为高中分化组(n=150)和低分化组(n=147),分析比较两组Ki-67表达水平和HRCT癌性结节特征性指标,如结节类型、大小、部位、毛刺、分叶、边缘、空洞、胸膜凹陷征、与血管关系、支气管充气征、伪空腔征。结果两组患者性别、结节类型、结节大小、胸膜凹陷征、伪空腔征、支气管充气征阳性、Ki-67表达水平差异有统计学意义(P<0.05)。Ki-67表达水平(OR=6.057,P<0.05)、结节性质(OR=6.523,P<0.05)、结节大小(OR=3.119,P<0.05)是低分化浸润性非黏液肺腺癌的独立风险因素,Ki-67表达水平与结节大小判定低分化浸润性非黏液肺腺癌的最佳截断值分别为14.5%与21.3 mm,两者联合诊断效能为0.888、敏感度为76.6%,特异度为89.3%,优于单独采用Ki-67表达水平或结节大小。结论Ki-67表达水平、结节性质、结节大小是预测低分化浸润性非黏液肺腺癌的独立风险因素,结节大小联合Ki-67表达水平能提高低分化癌细胞诊断准确率。

Objective To explore the predictive value of high-resolution CT(HRCT)image features combined with Ki-67 expression level in poorly differentiated invasive non-mucinous adenocarcinoma.Methods A total of 197 patients with invasive non-mucinous lung adenocarcinoma were selected from the General Hospital of PLA Central Theater Command and the 991th Hospital of PLA Joint Logistics Support Force from July 2015 to June 2023.According to the pathological results,they were divided into two groups,with 150 cases in highly and moderately differentiated group and 47 cases in poorly differentiated group.Ki-67 expression level and HRCT characteristic indicators of cancerous nodule lesions were analyzed and compared between the two groups,such as nodule type,size,location,burr,lobed,margin,cavity,relationship with blood vessels,air bronchial sign,false cavity sign.Results There were significant differences in gender,nodule type,nodule size,pleural indentation sign positive,pseudo cavity sign,bronchial inflation sign and Ki-67 expression level between the two groups(P<0.05).Ki-67 expression level(OR=6.057,P<0.05),nodule nature(OR=6.523,P<0.05)and nodule size(OR=3.119,P<0.05)were screened out as independent risk factors for poorly differentiated invasive non-mucinous lung adenocarcinoma(P<0.05).The best cut-off value of Ki-67 expression level and nodule size were 14.5%and 21.3 mm,respectively.The diagnostic efficacy,sensitivity and specificity of Ki-67 combined with Ki-67 expression level and nodule size were 0.888,76.6%and 89.3%,which were superior to Ki-67 expression level or nodule size alone.Conclusions Ki-67 expression level,nodule nature,nodule size are independent risk factors in predicting poorly differentiated invasive non-mucinous lung adenocarcinoma,and nodule size combined with the expression level of Ki-67 can improve the diagnostic accuracy of poorly differentiated cancer cells.