外周型小结节状肺腺癌淋巴结转移的相关因素分析

Related factors of lymph node status in small nodules of peripheral pulmonary adenocarcinoma

目的分析外周型小结节状肺腺癌患者手术前临床资料,寻找淋巴结转移的预测因素。方法回顾性分析第二军医大学附属长征医院胸心外科经手术治疗的68例表现为外周型小结节的肺腺癌患者,分析年龄、性别、吸烟史、癌胚抗原、影像学表现、手术方式、手术部位、肿瘤大小、病理分类、病理分期与淋巴结转移的关系。结果表现为纯磨玻璃影的11例患者中,4例为不典型腺瘤样增生,7例为原位腺癌,无一例发生淋巴结转移;表现为混合型磨玻璃影的27例患者中24例无淋巴结转移,只有3例患者发生淋巴结转移;而表现为实性结节的30例患者中共有7例发生淋巴结转移。影响肺腺癌的淋巴结转移的因素分别为肿瘤直径、影像学和癌胚抗原。结论表现为纯毛玻璃影的患者一般没有淋巴结转移,肿瘤直径大于lcm、影像学检测为混合性结节或实性结节、癌胚抗原≥5μg/L的肺腺癌患者更易发生淋巴结转移。

Objective This study aimed to investigate elinicopathological characteristics and find out the predictive factors of lymph node metastasis small nodules of peripheral pulmonary adenoearcinoma. Method We have a retro- spective review of 68 small nodules of peripheral plumonary adenocareinoma patients in the department of cardio- thoracic surgery, Changzheng Hospital affiliated to Second Military Medical University, and analysis interactive rela- tionships of their age, gender, smoking history, earcinoembryonie antigen （CEA） , imaging findings, surgical proce- dure, surgical site, tumor size, pathological classification, pathologic stage and lymph node metastasis. Result By pre- operative thin-section computed tomography （CT）, 11 patients are categorized as pure ground-grass opacity （GGO） , 4 cases of atypical adenomatous hyperplasia,7 cases of adenocareinoma in sitn,with no lymph node metastasis. Cate- gorized as mixed ground-glass opacities in 27 patients, 24 patients have no lymph node metastasis, only 3 patients had lymph node metastasis, categorized as solid nodules in 30 patients, a total of 7 cases had lymph node metastasis. By muhivariate analysis, we found that the predictive factors of lymph node metastasis were tumor size, imaging per- formance and earcinoembryonic antigen. Conclusion Patients of pure GGO generally do not have lymph node metas- tasis. Tumor diameter greater than 1 era, mixed GGO or solid nodules and CEA I〉5 ~g/L are related factors of lymph node metastasis.