280例cT1aN0M0肺腺癌淋巴结转移影响因素的回顾性分析

Retrospective analysis of the influential factors of lymph node metastasis in 280 cases of cT1aN0M0 lung cancer

目的 探讨临床上影响cT1aN0M0肺腺癌淋巴结转移的危险因素.方法 选取2013年1月至2015年12月280例cT1aN0M0肺腺癌患者的临床病例资料,对其淋巴结转移情况以及患者的临床因素进行回顾性统计分析.对患者的病理特征以及相关临床资料联合单一因素和多种因素共同分析,探讨cT1aN0M0肺腺癌淋巴结转移的影响因素.结果 经过医院对所有入选cT1aN0M0肺腺癌患者进行薄层CT扫描之后发现,280例cT1aN0M0肺腺癌患者中CT影像学类型为纯磨玻璃影108例（38.6%）,磨玻璃影带有实性成分（实性成分直径〈5 mm）117例（41.8%）,部分实性结节（实性成分直径≥5 mm）12例（4.3%）,纯实性结节43例（15.4%）.淋巴结转移28例（10.0%）,其中N1淋巴结转移16例（5.7%）,N2淋巴结转移12例（4.3%）.本研究对象中,所有实性成分直径〈5 mm及CT影像学类型为纯磨玻璃影的患者在经过手术治疗之后均未发现淋巴结转移情况.结论 临床上cT1aN0M0肺腺癌患者,若其影像学表现为纯磨玻璃影或实性成分直径〈5 mm则通常没有淋巴结转移情况发生.患者肿瘤直径〉1 cm,混合性结节和实性结节以及CEA〉5 μg/L等成为淋巴结转移的重要预测因素.通过行PET-CT患者中最大标准摄入值分析表明,当最大标准摄入值〉5时,患者更容易发生淋巴结转移.

Objective To investigate the risk factors of lymph node metastasis in cT1aN0M0 lung adenocarcinoma.Methods The clinical data of 280 cases of cT1aN0M0 lung adenocarcinoma admitted from January 2013 to December 2015 were selected, and the lymph node metastasis and clinical factors were retrospectively analyzed.The pathological characteristics and clinical data of the patients, combined with single factor and multiple factors analysis, the influence factors of lymph node metastasis of cT1aN0M0 lung adenocarcinoma were investigated.Results Thin slice CT scan found that 108 cases （38.6%） with the lung CT image typology for pure ground glass opacity, and 117 cases （41.8%） with CT imaging type of ground glass opacity （solid component diameter〈5 mm）, 12 cases （4.3%） with CT imaging type of part solid nodules （solid component diameter greater than or equal to 5 mm）, 43 cases （15.4%） with the CT images of pure solid nodules.There were 28 patients （10.0%） with lymph node metastasis, among which 16 patients （5.7%） with N1 lymph node metastasis and 12 patients （4.3%） with N2 lymph node metastasis.In this study, the patients with diameter less than 5 mm and CT imaging of pure ground glass opacity didn＆#39;t have lymph node metastasis after surgery.Conclusions Clinical cT1aN0M0 lung adenocarcinoma patients, if the imaging performance of pure grinding glass or solid components of the diameter is less than 5 mm, there is usually no lymph node metastasis occurred.The tumor diameter greater than 1 cm, mixed nodules and solid nodules and CEA〉5 μg/L were important prognostic factors for lymph node metastasis.Analysis of the maximum standard uptake value in patients with PET-CT show that patients are more likely to have lymph node metastasis, when the maximum standard uptake value is greater than 5.