恶性肺结节临床特点及淋巴结转移高危因素的logistic回归分析

Clinical features of malignant pulmonary nodules and logistic regression analysis of high-risk factors for lymph node metastasis

目的分析恶性肺结节的临床、影像及病理特点,探索淋巴结转移高危因素,为肺结节临床诊疗提供参考依据。方法通过病案管理系统回顾性收集2018-01-01-2020-12-31福建医科大学附属漳州市医院经手术切除后病理确诊为原发性肺癌的肺结节患者1168例,统计分析患者性别、年龄、吸烟情况、结节大小、影像学特征、病理类型、浸润程度及淋巴结转移情况等资料,logistic回归多因素分析探索恶性肺结节淋巴结转移的高危因素。结果1168例恶性肺结节患者平均年龄(56.79±11.53)岁,女性占57.79%(675/1168),79.8%(932/1168)患者未吸烟,62.24%(727/1168)位于双肺上叶,亚实性肺结节占68.24%(797/1168)。病理检查提示90.24%(1054/1168)为浸润性癌或微浸润癌,腺癌占94.01%(1098/1168),N_(1)淋巴结转移率5.74%(67/1168),N2转移发生率2.91%(34/1168)。logistic回归多因素分析发现结节增大、实性成分增多以及下叶肺结节为N_(1)淋巴结转移不良因素,而性别、年龄、吸烟状态不影响N_(1)淋巴结转移结局。结论肺恶性结节女性略多,肺上叶、亚实性结节常见,腺癌是最常见的病理类型,淋巴结转移概率较低。伴随着结节增大、实性成分增多及下叶结节,N_(1)淋巴结转移概率增加。

Objective To analyze the clinical, imaging and pathological characteristics of malignant pulmonary nodules, explore the high risk factors of lymph node metastasis, so as to provide a reference for the clinical diagnosis and treatment of pulmonary nodules.Methods Through the case management system, 1 168 patients with pulmonary nodules confirmed as primary lung cancer by pathology after surgical resection in Zhangzhou Hospital affiliated to Fujian Medical University from 2018-01-01 to 2020-12-31,and the gender, age, smoking, nodule size, imaging features, pathological type, degree of invasion and lymph node metastasis were statistically analyzed, and logistic regression multivariate analysis explored the high-risk factors of malignant pulmonary nodule lymph node metastasis.Results The average age of 1 168 patients with malignant pulmonary nodules was(56.79±11.53) years, 57.79%(675/1 168) of the patients were females, 79.8%(932/1 168) were non-smokers, 62.24%(727/1 168) were located in the upper lobes of both lungs, and 68.24%(797/1 168) were subsolid pulmonary nodules.Pathological examination showed that 90.24%(1 054/1 168) were invasive carcinoma or microinvasive carcinoma, adenocarcinoma accounted for 94.01%(1 098/1 168),N_(1) lymph node metastasis rate was 5.74%(67/1 168),and N_2 metastasis incidence was 2.91%(34/1 168).Logistic regression multivariate analysis showed that the increase of nodule size, solid components, and the lower lobe lung nodules were adverse factors of N_(1) lymph node metastasis, while gender, age and smoking status did not affect the outcome of N_(1) lymph node metastasis.Conclusions Lung malignant nodules are slightly more common in women, and upper lobe and subsolid nodules are common.Adenocarcinoma is the most prevalent pathological type, and the probability of lymph node metastasis is low.With the increase of nodule size and solid components, and the lower lobe lung nodules, the probability of N_(1) lymph node metastasis increases.