胸部CT征象对原发性小细胞肺癌脑转移的预测分析

CT Features of Primary Small Cell Lung Cancer and Its Predictive Value for Brain Metastasis

目的:分析原发性小细胞肺癌(SCLC)的胸部CT征象与脑转移的相关性。方法:回顾性分析118例经病理学确诊的SCLC患者的临床基本资料和胸部CT征象,其中发生脑转移49例和未发生脑转移69例。应用单因素和多因素Logistic回归分析探讨原发性小细胞肺癌的胸部CT征象与脑转移发生的相关性。结果:118例原发性SCLC中,男108例(91.5%)和女10例(8.5%),年龄≤60岁52例(44.0%)和>60岁66例(56.0%)。中央型84例(71.1%)和周围型34例(28.9%)。原发肿瘤大小(原发灶最长径)≤3cm为17例(14.4%)、>3cm且≤5cm为44例(37.3%)、>5cm且≤7cm为31例(26.3%)和>7cm为26例(22.0%)。CT-TN分期:CT-T1期15例(12.7%)、T2期18例(15.3%)、T3期11例(9.3%)和T4期74例(62.7%);CT-N0期10例(8.5%)、N1期15例(12.7%)、N2期59例(50.0%)和N3期34例(28.8%)。纵隔大血管受侵犯70例(59.3%),包括上腔静脉和主、叶肺动脉。胸膜受累24例(20.4%):包括胸腔积液和(或)胸膜结节或增厚。单因素分析(卡方检验)结果表明原发性SCLC患者的年龄、原发肿瘤部位、大小、CT-T、N分期及纵隔大血管情况是其发生脑转移的相关因素(P<0.05)。二元Logistic回归分析结果发现,年龄(>60岁)、原发肿瘤部位(中央型)、大小(>7cm)、CT-T4、CT-N3期及大血管侵犯与脑转移的发生有关(P<0.05),均为脑转移发生的危险因素。然而患者性别、胸膜情况与原发性SCLC脑转移的发生无相关性(P>0.05)。结论:原发性SCLC的原发肿瘤部位(中央型)、大小(>7cm)、CT-T4、CT-N3期及纵隔大血管侵犯对脑转移的发生具有一定的预测价值。

Objective:To analyze the characteristic CT signs of primary small cell lung cancer(SCLC) and its correlation with the occurrence of brain metastasis. Methods:A total of 118 patients with SCLC confirmed by pathology were enrolled in the study, including 49 patients of brain metastases and 69 of non-brain metastases. The correlation between chest CT signs and SCLC brain metastasis was further analyzed by univariate and multivariate logistic regression analysis. Results:Of the 118 patients with primary SCLC, 108 patients were men and 10 were women, 52 cases were ≤60 years old, and 66 were >60 years old. There were 84 cases in the central type and 34 cases in the surrounding type. The size of the primary tumor(the longest diameter of the primary lesion) ≤3 cm was 17 cases(14.4%), >3 cm and ≤5 cm for 44 cases(37.3%), > 5 cm and ≤7 cm for 31 cases(26.3%) and >7 cm It was 26 cases(22.0%). There were 15 cases in CT-T1, 18 cases in T2 stage, 11 cases in T3 stage and 74 cases in T4 stage. The CT-N0 was 10, the N1 was 15, the N2 was 59, and the N3 was 34.70 cases were involved in mediastinal large vessels, including the pulmonary artery or superior vena cava. Pleural condition: pleural effusion and/or pleural nodules or thickening in 24 cases. Univariate analysis(Chi-square test) showed that age, primary tumor location, size, CT-T, CT-N stage, and mediastinal macrovascular disease were the relevant factors for brain metastasis in primary SCLC(P<0.05). Binary logistic regression analysis showed that age(>60 years), primary tumor site(the central type), size(>7 cm), CT-T4, CT-N3 phase and macrovascular invasion were associated with brain metastasis(P<0.05), which were risk factors for brain metastasis. There were no significant difference between gender, pleural condition and SCLC brain metastasis(P>0.05). Conclusion:Partial CT signs of primary SCLC have certain clinical value for the prediction of SCLC brain metastasis, including primary tumor site(central type), size(>7 cm), CT-T4, CT-N3 and mediastinal large vessels invasion are risk factor for SCLC brain metastasis.