三维立体测量法测量cT1期NSCLC肿瘤-肺门空间距离及其与淋巴结转移的关系

Three Dimensional Measurement of the Space Distance Between the Hilum and Clinical Stage T1 Non-small Cell Lung Cancer and Its Relationship with Lymph Node Metastasis

目的建立一种新的测量肿瘤与肺门空间距离(肿瘤-肺门空间距离)的方法,并研究用该方法测量的肿瘤-肺门空间距离与临床T1期(cT1期)非小细胞肺癌淋巴结转移的关系。方法本研究通过三维立体测量法测量肿瘤中心CT层面与肺门CT层面的垂直距离,并测量肿瘤中心在肺门CT层面的垂点与肺门的距离,将二维CT图像中的数据转化为三维CT数据,并通过立体几何学定理计算肿瘤-肺门空间距离。获得所有空间距离的相关数据后,通过回顾性研究分析肿瘤-肺门空间距离是否为cT1期非小细胞肺癌淋巴结转移的独立危险因素。结果成功建立一种新的测量肿瘤-肺门空间距离的三维立体测量法。共纳入399例cT1期非小细胞肺癌患者,男性166例,女性233例,平均年龄(57.48±10.88)岁,肿瘤-肺门空间距离(5.44±1.96)cm,肿瘤直径(1.77±0.65)cm。根据是否存在淋巴结转移分为淋巴结转移组(N+组)和无淋巴结转移组(N-组)。多因素分析显示女性〔比值比(OR)=2.118,P=0.022〕、肿瘤-肺门空间距离(OR=0.843,P=0.040)、分化程度降低(中分化,OR=15.547,P=0.008;低分化,OR=70.749,P=0.000)、淋巴管内有癌栓(OR=24.769,P=0.004)为cT1期非小细胞肺癌淋巴结转移的独立危险因素。结论本研究通过三维立体测量法测量cT1期非小细胞肺癌肿瘤-肺门空间距离,并发现采用该方法测量的肿瘤-肺门空间距离为cT1期非小细胞肺癌淋巴结转移的独立危险因素。

Objective The aim of this study was to develop a novel method to quantitatively define the tumor location of clinical stage T1(cT1)non-small cell lung cancer(NSCLC)and to evaluate its impact on lymph node metastasis in a large cohort group.Methods We developed a novel method to transform the datum of 2 D CT scans to 3 D datum and to quantitatively measure the distance between the tumor and hilum through the Pythagorean theorem.Multiple logistic regression analysis was applied to identify the risk factors associated with lymph node metastasis.Results A total of 399 patients(166 male and 233 female)with cT1 NSCLC were enrolled in this study.The mean age was(57.48±10.88)yr.,the mean distance between tumor and hilum was(5.44±1.96)cm,and the mean tumor diameter was(1.77±0.65)cm.Patients were divided into lymph node positive group(N+group)and lymph node negative group(N-group).By multiple logistic regression analysis,we identified 4 risk variables associated with lymph node metastasis.Gender(odds ratio(OR)=2.118,P=0.022),distance between tumor and hilum(OR=0.843,P=0.040),differentiation(moderate vs.high,OR=15.547,P=0.008;poor vs.high,OR=70.749,P=0.000),and cancer embolus(OR=24.769,P=0.004)were independent risk variables associated with lymph node metastasis.Conclusion Distance between tumor and hilum was identified as an independent risk factor associated with lymph node metastasis in cT1 NSCLC.