非小细胞肺癌隐匿性淋巴结转移危险因素分析

Risk factors for occult lymph node metastasis in patients with non-small cell lung cancer

目的隐匿性淋巴结转移(occult lymph node metastasis,OLM)对肺癌临床分期非常重要,如何将OLM低危人群筛查出来,以便外科医生制定合适的治疗方案是目前研究热点。本研究探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)患者隐匿性淋巴结转移影响因素。方法收集2009-07-15-2016-05-15南京医科大学第一附属医院收治的337例NSCLC患者临床资料,术前PET/CT显像诊断均为临床N0期。通过单因素及多因素分析筛选出隐匿性淋巴结转移的独立危险因素。结果 337例NSCLC患者,术后病理确诊淋巴结转移90例(26.7%,90/337),其中N1淋巴结转移46例,N2淋巴结转移44例。单因素分析结果显示,肿瘤位置、肺膜侵犯、脉管浸润、肿瘤最大径、SUVmax和病灶糖酵解总量(total lesion glycolysis,TLG)为NSCLC隐匿性淋巴结转移的危险因素,均P<0.05。多因素分析结果显示,脉管浸润(OR=3.453,95%CI=1.321~9.082,P=0.011)、肿瘤最大径(OR=1.850,95%CI=1.030~13.322,P=0.039)、TLG(OR=3.092,95%CI=1.124~8.510,P=0.029)是隐匿性淋巴结转移的独立危险因素。根据TLG与肿瘤最大径将患者分为低危组(n=125)、中危组(n=106)及高危组(n=106),3组患者隐匿性淋巴结转移的发生率分别为8.8%(11/125)、23.6%(25/106)和50.9%(54/106),差异有统计学意义,χ2=52.815,P<0.001。结论脉管浸润、肿瘤最大径及18F-FDG PET/CT显像所测得的TLG是NSCLC隐匿性淋巴结转移的独立危险因素,18 F-FDG PET/CT显像结果可为外科制定手术方案提供一定的参考价值。

OBJECTIVE Occult lymph node metastasis（OLM） is important for the clinical staging of lung cancer. How to screen OLM patients with low risk so that surgeons can develop appropriate treatment plans is a hot topic of cur rent research. This study aimed to assess risk factors in NSCLC with occult OLM. METHODS Records of 337 patients with N0 stage NSCLC staged by preoperation 18 FFDG PET/CT between July 15th 2009 and May 15th 2016 were retro- spectively reviewed. To identify risk factors for occult lymph node metastasis, univariate and multivariate logistic regres- sion analyses were performed. RESULTS Of 337 patients, 90 （26. 7%,90/337） had OLM conformed by pathology; 46 were N1 and 44 were N2. In univariate analysis, six risk factors were identified： tumor location, pleural invasion, vascular invasion, tumor size, SUVm,x and TLG （all P〈0.05）. On multivariate analyses, vascular invasion （ OR = 3.453,95 M CI = 1.321-9.082,P=0. 011）,tumor size （OR=1. 850,95%CI=1. 030--13. 322,P=0. 039） and TLG （OR=3. 092, 95MCI=1.124--8.510,P=0. 029） were the independent risk factors for OLM. According the TLG and tumor size,pa tients were divided into three groups：low-risk group（n = 125 ）, moderate-risk group （n=106） and high-risk group （n = 106）. The OLM rates of the three groups were 8.8%（11/125） ,23.6%（25/106） ,50.9%（54/106） ,respectively,with sig- nificant difference（X^2 =52. 815,P〈0. 001）. CONCLUSIONS Vascular invasion, tumor size and TLG measured on 18F-FDC- PET/CT are the independent Dredictive risk factors for OLM. 18 F-FDG PET/CT can be used to guide surgical Dlanning.