基于PET/CT的Ⅳ期肺癌转移特点的临床分析

Clinical metastatic characteristics of stage Ⅳ lung cancers based on PET / CT scanning

目的应用PET/CT探讨晚期肺癌远处转移的特点。方法分析我院2008-2013年631例有明确病理学诊断的Ⅳ期肺癌患者PET/CT的检查结果,分析淋巴结及各器官远处转移发生率及其与病理类型和其他临床特征的关系。结果 631例晚期肺癌患者,小细胞肺癌(SCLC)和鳞癌(SCC)肺门淋巴结转移率明显高于腺癌(AC)(P<0.01),锁骨上淋巴结转移率明显低于AC(P<0.01)。较SCC,SCLC和AC更易发生腹腔淋巴结转移(P<0.01)。远处转移中,AC较其他病理类型更易发生胸膜(P<0.05)、骨(P<0.01)、脑转移(P<0.01)。SCLC肝转移明显高于AC和SCC(P<0.05)。SCC肾上腺转移明显低于其他病理类型(P<0.05)。脊柱为最常见的骨转移部位。结论PET/CT对于诊断Ⅳ期肺癌患者远处转移有较高价值。Ⅳ期肺癌的转移与病理组织学类型明显相关,其中AC转移发生率最高,转移部位最广,且较易侵犯人体的重要生命器官,应予高度重视。

Objective To investigate the metastatic characteristics of lung cancers with stage IV based on the results of PET/CT scanning. Methods The PET/CT data of 631 patients with definite pathologically diagnosed stage IV lung cancer in our hospital during the years of 2008 to 2013 were collected. The metastatic rates of different pathological types of lung cancer were analyzed and compared statistically. Results In the enrolled 631 patients with advanced lung cancer, the incidence of hilar lymph node metastasis were significantly higher, and that of mediastinal and supraclavicular lymph nodes metastasis were significantly lower in small cell lung cancer （SCLC） and squamous cell carcinomas （SCC） than adenocarcinoma（AC） （both P 〈 0.01 ）. The incidence of abdominal lymph node metastasis was significantly lower in SCLC and AC compared with SCC （P 〈 0.01 ）. The rates of pleura, brain and bone metastasis were significantly higher in the patients with AC than those with SCLC or SCC （ pleura P 〈 0.05, brain P 〈 0.01, bone P 〈 0.01 ）. The rate of liver metastasis was significantly higher in patients with SCLC compared with AC and SCC （P 〈 0.05 ）. The rate of adrenal metastasis was significantly lower in the patients with SCC compared with SCLC and AC （ P 〈 0.05 ）. The most common bone metastatic sites were soine. Conclusion PET/CT scanning is of higher value for the diagnosis of stage IV metastatic lung cancer patients. The metastasis of lung cancer is significantly associated with histological types. We should pay close attention to AC because of its highest incidence of cancer metastasis, most widely metastatic sites, and easier to violations of human vital organs.