肺腺癌脏层胸膜侵犯的影响因素分析

Analysis of Influencing Factors of Visceral Pleura Invasion in Lung Adenocarcinoma

目的:探讨肺腺癌脏层胸膜侵犯(VPI)的影响因素。方法:回顾性分析2017年3月-2019年12月厦门大学附属第一医院杏林分院收治的137例肺腺癌患者的临床资料。所有患者均进行多层螺旋CT检查、病理学检查,并进行分组。收集所有患者临床资料。统计分组情况,对肺腺癌VPI发生的影响因素进行单因素和Logistic分析。结果:137例肺腺癌患者中共有35例发生VPI,发生率为25.55%,纳入VPI组,102例未发生VPI,纳入N-VPI组。VPI组术前癌胚抗原(CEA)水平≥10 ng/ml、高分化、有胸膜凹陷征、有分叶征、实性结节、发生EGFR突变占比均明显高于N-VPI组,肿瘤直径、肿瘤实性成分长径均明显长于N-VPI组,病变至胸膜最小距离(DLP)短于N-VPI组(P<0.05)。Logistic分析显示,术前CEA水平、肿瘤直径、DLP短、肿瘤实性成分长径、结节性质、EGFR突变均是肺腺癌发生VPI的独立危险因素(P<0.05)。结论:肺腺癌VPI的患者多层螺旋CT可见胸膜凹陷征、分叶征,术前CEA水平、肿瘤直径、DLP短、肿瘤实性成分长径、结节性质、EGFR突变是影响VPI发生的独立危险因素。

Objective:To investigate the influencing factors of visceral pleura invasion(VPI)in lung adenocarcinoma.Method:The clinical data of 137 patients with lung adenocarcinoma admitted to Xinglin Branch of the First Affiliated Hospital of Xiamen University from March 2017 to December 2019 were analyzed retrospectively.All patients underwent multi-slice spiral CT examination,pathological examination,and were divided into groups.The clinical data of all patients were collected.The grouping situation was counted,and the influencing factors of the occurence of VPI in lung adenocarcinoma were analyzed by single factor and Logistic.Result:A total of 35 cases among 137 patients with lung adenocarcinoma developed VPI,with an incidence of 25.55%.They were included in the VPI group,and 102 cases without VPI were included in the N-VPI group.The proportions of preoperative carcinoembryonic antigen(CEA)level≥10 ng/ml,highly differentiated,with pleural indentation sign,with lobulation sign,solid nodules and EGFR mutations in VPI group were significantly higher than those in N-VPI group.The tumor diameter and tumor solid component length were significantly longer than those in N-VPI group,and minimum distance from lesion to pleura(DLP)was shorter than that in N-VPI group(P<0.05).Logistic analysis showed that preoperative CEA level,tumor diameter,shorter DLP,tumor solid component length,nodule nature and EGFR mutation were independent risk factors for the occurence of VPI in lung adenocarcinoma(P<0.05).Conclusion:In patients with VPI of lung adenocarcinoma,pleural indentation sign and lobulation sign can be seen on multi-slice spiral CT.Preoperative CEA level,tumor diameter,shorter DLP,tumor solid component length,nodule nature and EGFR mutation are independent risk factors affecting the occurrence of VPI.