胸膜下肺腺癌脏层胸膜侵犯CT及临床风险因素

A study on CT and clinical risk factors of visceral pleural invasion in subpleural lung adenocarcinoma

目的:分析肿瘤-胸膜最小距离(DLP)≤1 cm且肿瘤直径≤3 cm肺腺癌CT特征、临床及病理资料,建立风险评分模型量化分析脏层胸膜侵犯风险因素。方法:分析大连市2家三甲医院共计356例DLP≤1 cm且直径≤3 cm肺腺癌患者CT特征、临床及病理资料,分为胸膜侵犯组(VPI)、非胸膜侵犯组(N-VPI)。将单因素分析中有统计学意义因素纳入多因素logistic回归分析,据胸膜侵犯独立危险因素优势比(OR)值建立预测胸膜侵犯风险评分模型,绘制受试者工作特征曲线(ROC)评估其预测效能。结果:经病理确诊356例肺腺癌中VPI组94例(26.4%),N-VPI组262例(73.6%)。多因素logistic回归分析发现术前CEA、肿瘤直径、肿瘤实性成分长径及DLP是脏层胸膜侵犯独立危险因素(P<0.05),建立风险评分模型=3(术前CEA≥5 ng/mL)+8(肿瘤实性成分长径≥0.8 cm)+2(肿瘤直径≥1.6 cm)+7(DLP≤0.6 cm),该评分模型预测VPI cut-off值11,ROC曲线下面积(AUC)0.819,敏感度、特异度分别为89.4%,68.7%。结论:术前CEA、肿瘤直径、实性成分长径及DLP是胸膜下肺腺癌脏层胸膜侵犯独立危险因素,其风险评分模型>11时提示很可能存在脏层胸膜侵犯。

Objective:The CT features,clinical and pathological data of lung adenocarcinoma with minimum distance from the lesion to the pleura≤1cm and tumor diameter≤3cm were analyzed,and a risk score model was established to quantify the risk factors of visceral pleural invasion.Methods:The CT characteristics,clinical and pathological data of 356 patients with lung adenocarcinoma in two hospitals of Dalian were retrospectively collected and analyzed.All cases were divided into pleural invasion group(VPI)and non-pleural invasion group(N-VPI).Univariate analysis was performed for all variables,and then statistically significant factors in univariate analysis were included in multivariate logistic regression analysis.Based on the odds ratio(OR)of independent risk factors for pleural invasion,a risk score model for predicting pleural invasion was established.Receiver operating characteristic curve(ROC)was drawn to evaluate the prediction effectiveness of the prediction model.Results:Of the 356 cases of lung adenocarcinoma,94(26.4%)lesions were in the VPI group and 262(73.6%)in the N-VPI group.Multivariate logistic regression analysis showed that preoperative CEA,tumor diameter,solid-portion size,and DLP were independent risk factors for visceral pleural invasion(P<0.05).Risk score model=3(preoperative CEA≥5ng/mL)+8(solid portion size≥0.8cm)+2(tumor diameter≥1.6cm)+7(DLP≤0.6cm).The cut-off value of the scoring model for predicting VPI is 11,the area under curve(AUC)is 0.819,the sensitivity and specificity are 89.4%and 68.7%,respectively.Conclusion:Preoperative CEA,tumor diameter,solid-portion size,and DLP are independent risk factors for visceral pleural invasion of subpleural lung adenocarcinoma.When the total score exceeds 11 points,it may indicate that visceral pleural invasion could be occurred.