周围型肺癌间质比例与CT表现的关系

Correlation between the Interstitium of the Peripheral Lung Cancer and the CT Findings

目的：探讨周围型肺癌间质与转移、预后以及ＣＴ表现的关系。材料和方法：利用Ｇｒｏｃｏｔ六胺银染色法测定８７例肺癌的间质主质比，并与ＣＴ表现以及转移、预后情况进行对照分析。结果：鳞癌间质多于腺癌，间质成分的比例与肿瘤大小无直接联系。虽然有分叶征的病例在我们观察的时候瘤内肿瘤主质及间质分布显得很不均匀，但有无分叶征的病人各评分之间并无显著性差异（Ｐ＞０．０５）。不同的瘤肺交界面之间除毛刺征者少间质比例较高外其它无明显差别。胸膜凹陷征与瘤体间质的胶原成分也无显著关联。虽然增强程度不同，其间质比例亦略不同，既增强明显的间质成分略多，增强差一点的间质成分略少。但统计学处理表明，两组差别不显著（Ｐ＞０．０５）。与肺癌微血管密度相关性的比较显示也无显著相关（嗜银染色积分１－２分的ＭＶＤ平均５０．１３±１４．５６，积分３－５分的ＭＶＤ平均５３．６７±１２．７１），这说明肺癌增强程度与间质无明显关联。统计学处理表明，有淋巴结转移组间质多的（积分３－５分）仅占３２．５％，无淋巴结转移的占９０．４％，两者差别显著（Ｐ＜０．０１）。说明肺癌间质对其淋巴结转移有阻挡作用。从随访资料看，死亡组及存活远处转移组的积分明显低于存活组无转移病?

Purpose:To study the interstitum of the lung cancers by silver staining in order to find out the inter-relation among the tumor interstitium,metastasis,prognosis and CT features.Materials and Methods:87 patients with peripheral lung cancer were selected for tumoral interstitium studies by silver staining usng Grocott method.The results were compared with the clinical conditions such as metastasis,prognosis and CT findings.Results:It was shown that the squamous cell carcinoma tended to have more interstitium than adenocarcinoma.High score(3-5 points) of interstitium in patients with nodal metastasis and in patients without nodal metastasis were 32.5% and 90.4% respectively outcoming with significant difference(P<0.01).The scores of interstitium in patients died and those with remote metastasis were much lower than those in patients without metastasis(P<0.05).It suggested that the interstitium played an important role in the barrier to the nodal metastasis and positively.related to the patient's prognosis.The CT findings such as tumor size,lobulated character and different kinds of margins(except spiculation) appeared to have no relations to the interstitium.Although tumors with pleural puckering might be looked like to have more interstitium,but actually not so signifcant.Comparing The interstitium with MVD and the degree of enhancement of tumors showed no correlations.Conclusion:The interstitium is closely related to the malignancy,metastasis,and prognosis of the lung cancer,but without definite correlation with CT features(except spiculation sign)and necessarily to be further studied.