小结节型ⅠA期肺腺癌胸膜侵犯危险因素分析

Risk factors analysis for pleural invasion in small nodular typeⅠA lung adenocarcinoma

目的探讨分析小结节型ⅠA期肺腺癌胸膜侵犯的危险因素。方法回顾性分析2016年6月至2017年12月南京医科大学第一附属医院168例ⅠA期肺腺癌手术患者的临床资料,其中男59例、女109例,年龄28~83(58.7±11.5)岁。采用单因素χ^2检验与多因素logistic回归分析调查小结节ⅠA期肺腺癌胸膜侵犯的危险因素。结果 168例小结节型ⅠA期肺腺癌患者病理确诊胸膜侵犯20例(11.9%),无胸膜侵犯148例(88.1%),χ^2检验分析发现患者结节直径、性质、肿瘤-胸膜空间位置分型(RLP)、病变至胸膜最小距离(DLP)、病理类型、表皮生长因子受体(EGFR)突变在有、无胸膜侵犯差异具有统计学意义(P均<0.05)。Logistic多因素回归分析发现结节直径、性质、RLP、DLP、EGFR突变对胸膜侵犯差异均有统计学意义(P均<0.05),是胸膜侵犯的独立危险因素。结论小结节型ⅠA期肺腺癌患者影像-病理-生物学特征与胸膜侵犯密切相关,临床诊治应综合上述参数评估胸膜侵犯的可能性。

Objective To explore and analyze the risk factors of pleural invasion in patients with small nodular type stage ⅠA pulmonary adenocarcinoma. Methods From June 2016 to December 2017, 168 patients with small nodular type stage ⅠA pulmonary adenocarcinoma underwent surgical resection in the First Affiliated Hospital of Nanjing Medical University. There were 59 males and 109 females aged 58.7±11.5 years ranging from 28 to 83 years. The clinical data were analyzed retrospectively. Single factor Chi-square test and multivariate logistic regression were used to analyze the independent risk factors of pleural invasion. Results Among 168 patients, 20(11.9%) were pathologically confirmed with pleural invasion and 148(88.1%) with no pleural invasion. Single factor analysis revealed significant differences(P<0.05) in nodule size, nodule status, pathological type, relation of lesion to pleura(RLP), distance of lesion to pleura(DLP), epidermal growth factor receptor(EGFR) mutation between patients with and without pleural invasion in stage ⅠA pulmonary adenocarcinoma. Logistic multivariate regression analysis showed that significant differences of nodule size, nodule status, RLP, DLP and EGFR mutation existed between the two groups(P<0.05), which were independent risk factors for pleural invasion. Conclusion Imageological-pathological-biological characteristics of patients with small nodular type stage ⅠA pulmonary adenocarcinoma are closely related to pleural invasion. The possibility of pleural invasion should be evaluated by combining these parameters in clinical diagnosis and treatment.