浸润性肺腺癌气腔播散的CT、临床与病理特征对照分析

Comparative analysis of the CT,clinical,and pathological features of patients with invasive lung adenocarcinoma positive and negative for spread through air spaces

目的探讨浸润性肺腺癌患者肿瘤经气腔播散(STAS)的计算机断层成像(CT)、临床与病理特征的相关性。方法选取经手术病理证实的浸润性肺腺癌患者236例,STAS阳性及阴性组各118例,收集并分析2组患者临床资料、CT征象、病理特征。结果患者年龄与STAS的发生具有一定相关性,阳性组年龄大于阴性组,吸烟史、肿瘤家族史与STAS的发生无相关性。CT征象中结节类型、形态、瘤-肺界面、分叶征、毛刺征、空泡/空洞、空气支气管征、胸膜凹陷征、血管改变、肿瘤平均径线、实性成分平均径线、实性成分占比值在STAS发生存在明显不同;实性结节/部分实性结节STAS发生率明显高于磨玻璃结节;多因素分析显示实性成分占比值、空气支气管征、分叶征、瘤-肺界面是预测STAS发生的独立危险因素。结论浸润性肺腺癌患者临床特征、CT征象与STAS的发生存在一定的相关性,肿瘤实性成分占比值、空气支气管征、分叶征、瘤-肺界面等CT征象对于预测STAS的阳性与否有着重要意义,为临床选择个性化治疗方案提供重要依据。

Objective To investigate the correlations of computed tomography(CT),clinical,and pathological features in patients with invasive lung adenocarcinoma positive and negative for spread through air spaces(STAS).Methods A total of 236 patients with invasive lung adenocarcinoma confirmed by surgery and pathology were selected,including 118 patients in STAS-positive group and 118 patients in STAS-negative group.The clinical data,CT signs,and pathological features of the two groups were collected and analyzed.Results There was a correlation between age and the occurrence of STAS.The age of the positive group was higher than that of the negative group.Smoking history and family history of tumor had no correlation with the occurrence of STAS.CT features signs such as nodule type and shape,tumor-lung interface,lobulation sign,spiculation sign,vacuole/cavity,air-bronchogram,pleural indentation sign,vascular changes,mean diameter of tumor,mean diameter of solid component,and the percentage of tumor solid components were significantly different between patients with and without STAS.The incidence of STAS in patients with solid nodules and partial solid nodules was significantly higher than that in patients with ground glass nodules.Multivariate analysis showed that the percentage of tumor solid components,air-bronchogram sign,lobulation sign,and tumor-lung interface were independent risk factors for predicting the occurrence of STAS.Conclusion The clinical data and CT signs of patients with invasive lung adenocarcinoma are related to the occurrence of STAS.CT signs such as the percentage of tumor solid components,air-bronchogram,lobulation sign,and tumor-lung interface are of great significance to STAS prediction.Our findings provide an important basis for selection of personalized clinical treatment plans.