可切除肺癌伴发肺结节良恶性的多因素分析

Multivariate Analysis of Benign and Malignant Risk Factors of Pulmonary Nodules Accompanied With Resectable Lung Cancer

目的分析可切除肺癌伴发的肺结节的临床特征,探讨恶性结节的预测指标,为优化手术切除范围提供科学依据。方法纳入2013年9月~2019年12月我院手术治疗的肺癌同时存在伴发肺结节患者,收集患者的人口学特征,临床及影像学资料及病理结果,对良恶性伴发肺结节的特征进行单因素及多因素分析。结果共入组93例,以女性(77.4%)和不吸烟者(83.9%)为主。与可切除肺癌结节同时存在的伴发结节共127枚,以纯磨玻璃结节为主(85.0%)。恶性结节共61枚(48.0%)。多因素分析显示:伴发结节血管集束征(OR=12.94,95%CI:4.02~41.67,P=0.000),空泡征(OR=7.29,95%CI:1.99~26.74,P=0.003),分叶征(OR=3.82,95%CI:1.14~12.78,P=0.029),直径>8 mm(OR=3.41,95%CI:1.07~10.85,P=0.037)为伴发肺结节为恶性的独立危险因素。结论伴发结节大小、分叶征、空泡征、血管集束征有助于对肺癌伴发的肺结节良恶性的判断。

Objective To analyze the clinical features of pulmonary nodules accompanied with resectable lung cancer,and explore the predictive indexes of malignant nodules,so as to provide scientific basis for optimizing the surgical resection range.Methods From September 2013 to December 2019,the patients with lung cancer accompanied with pulmonary nodules who underwent surgery in our hospital were included.The demographic characteristics,clinical and imaging data and pathological results of the patients were collected.The characteristics of benign and malignant pulmonary nodules were compared and univariate and multivariate analysis was performed.Results A total of 93 patients were enrolled,mainly female(77.4%)and non-smokers(83.9%).There were 127 accompanied nodules with resectable lung cancer nodules,mainly pure ground glass nodules(85.0%).There were 61 malignant nodules(48.0%).Multivariate analysis showed that vascular convergence sign(OR=12.94,95%CI:4.02-41.67,P=0.000),vacuole sign(OR=7.29,95%CI:1.99-26.74,P=0.003),lobulated sign(OR=3.82,95%CI:1.14-12.78,P=0.029),and the nodule diameter>8 mm(OR=3.41,95%CI:1.07-10.85,P=0.037)were independent risk factors for malignant nodules.Conclusion The nodule size,lobulated sign,vacuole sign and vascular convergence sign are helpful to judge the benign and malignant of pulmonary nodules accompanied with lung cancer.