胸部薄层CT对早期浸润性肺腺癌术后复发/转移的预测能力

Predictive Ability of Chest Thin-Layer CT for Postoperative Recurrence/Metastasis of Early Invasive Lung Adenocarcinoma

目的探讨胸部薄层CT对早期浸润性肺腺癌(IAC)术后复发/转移的预测能力。方法选取2020年1月至2023年1月新乡医学院第三附属医院收治的120例早期IAC患者进行回顾性研究,根据术后是否发生复发/转移分为发生组(24例)、未发生组(96例)。比较两组胸部薄层CT结果,采用受试者工作特征(ROC)曲线分析胸部薄层CT对术后复发/转移的预测价值,并比较不同病理亚型患者胸部薄层CT结果。结果发生组空泡征、血管征、支气管征、胸膜凹陷征、毛刺征占比及结节长径、实性成分占比、实性成分长径、结节CT值、CT值比、CT值/体积高于未发生组(P<0.05);胸部薄层CT结果中,CT值比预测术后复发/转移的曲线下面积(AUC)为0.814,CT值/体积预测复发/转移的敏感度最大,胸膜凹陷征、毛刺征预测复发/转移的特异度最高,CT值/体积、胸膜凹陷征、毛刺征联合预测复发/转移的AUC为0.924;空泡征在贴壁为主型中出现的频率高于非贴壁为主型,胸膜凹陷征、分叶征在非贴壁为主型中出现的频率高于贴壁为主型(P<0.05);有微乳头患者实性成分长径大于无微乳头患者(P<0.05)。结论胸部薄层CT部分影像学特征与早期IAC病理亚型及术后复发/转移相关,其中CT值/体积、胸膜凹陷征、毛刺征联合应用对术后复发/转移具有一定预测价值,可作为临床评估术后复发/转移及病理亚型的有效检查方式之一。

Objective To investigate the predictive ability of chest thin-layer CT in postoperative recurrence/metastasis of early invasive lung adenocarcinoma(IAC).Methods A retrospective study was conducted on 120 patients with early IAC admitted to the Third Affiliated Hospital of Xinxiang Medical University from January 2020 to January 2023.They were divided into two groups(24 cases)and 96 cases(96 cases)according to whether recurrence/metastasis occurred after operation.The results of chest thin-layer CT were compared between the two groups.The predictive value of chest thin-layer CT in postoperative recurrence/metastasis was analyzed by receiver operating characteristic(ROC)curve,and the results of chest thin-layer CT in patients with different pathological subtypes were compared.Results The occurrence of cavitation,vascular,bronchial,pleural indentation and burr signs in the group with lung nodules was higher than that in the group without lung nodules(P<0.05).Among the chest thin-layer findings,the area under the curve(AUC)of CT value ratio predicting the postoperative recurrence/metastasis was 0.814.The CT value/volume had the highest sensitivity for predicting recurrence/metastasis.The pleural indentation and burr signs had the highest specificity for predicting recurrence/metastasis.The CT value/volume,pleural indentation combined with burr signs had the highest AUC for predicting recurrence/metastasis,with a value of 0.924.The frequency of cavitation sign in the mainly adherent type was higher than that in the mainly non-adherent type,and the frequency of pleural indentation sign and lobulated sign in the mainly non-adherent type was higher than that in the mainly adherent type(P<0.05).The long diameter of solid components in patients with micropapillae was greater than that in patients without micropapillae(P<0.05).Conclusion Some imaging characteristics of chest thin-layer CT are associated with early pathological subtypes of IAC and postoperative recurrence/metastasis.The combined application of CT value/volume,pleural indentation sign and spiculation sign has certain predictive value for postoperative recurrence/metastasis,and can be used as an effective examination method for clinical evaluation of postoperative recurrence/metastasis and pathological subtypes.