经手术切除肺癌肿瘤大小测量和临床T分期准确性:1880例患者的回顾性分析

The accuracy of tumor size measurement and clinical T staging for resected lung cancer:Retrospective analysis of 1880 patients

目的阐明影像学肿瘤大小(radiological tumor size,RTS)与病理学肿瘤大小(pathological tumor size,PTS)的相关性,并评估临床T分期的准确性。方法回顾性分析2018年9月—2019年6月于复旦大学附属肿瘤医院接受根治性切除术肺癌患者的临床资料。分析RTS和PTS之间的相关性,并评估临床和病理T分期之间的一致性。结果共纳入1880例患者,男778例、女1102例,平均年龄(57±11)岁。在整体队列中,RTS和PTS分别为(19.1±13.5)mm和(17.7±14.0)mm(P<0.001)。RTS与PTS呈强线性相关,Pearson相关系数为0.897。在≤3 cm的肿瘤中,RTS平均值显著大于PTS平均值(P<0.001),而在>4 cm的肿瘤中,RTS平均值显著小于PTS平均值(P<0.05)。临床与病理T分期的总体一致率为65.6%。29.4%(5/17)的患者临床分期未检出T4疾病。男性及结节内存在空腔是导致临床T分期不准确的独立危险因素(P<0.05)。结论RTS与PTS的相关性与实际肿瘤大小有关。临床上迫切需要开发提高临床T分期准确性的方法和技术。

Objective To elucidate the correlation between radiological tumor size(RTS)and pathological tumor size(PTS),and to evaluate the accuracy of clinical T staging.Methods Data on patients who underwent complete resection between September 2018 and June 2019 were retrospectively collected.The correlation between RTS and PTS was analyzed by and we assessed the agreement between clinical and pathologic T staging.Results Finally,1880 patients were included.There were 778 males and 1102 females at average age of 57±11 years.In the entire cohort,the RTS and PTS was 19.1±13.5 mm and 17.7±14.0 mm,respectively(P<0.001).The RTS and PTS showed a strong linear correlation with the Pearson’s correlation coefficient calculated as 0.897.The mean RTS was significantly larger than PTS(P<0.001)in tumors≤3 cm,but significantly smaller in tumors>4 cm.The overall concordance rate between clinical and pathological T staging was 65.6%.Clinical staging failed to detect T4 disease in 29.4%(5/17)of patients.Male patients and the presence of cavities within nodules were independent significant factors leading to inaccurate clinical T staging.Conclusions The correlation between the tumor sizes measured on thin-section computed tomography and pathologic specimens varies with the real tumor size.Methods and techniques for improving clinical T staging accuracy is in urgent need.