早期多原发与单发肺腺癌结节的临床特征及淋巴结转移风险对比

A comparative study of clinical features and lymph node metastasis risk between early multi⁃primary and singlee pulmonary adenocarcinoma nodules

目的探讨多原发肺腺癌结节与单发肺腺癌结节的临床特征和淋巴结转移风险差异。方法回顾分析南方医科大学珠江医院胸外科于2022~2023年收治的手术患者212例,其中单发肺腺癌结节(149例)和多原发肺腺癌结节(63例),经倾向性评分匹配后比较两组影像学特征、肿瘤血清学指标、病理免疫组化及淋巴结转移率,运用二元logistic回归探讨单发与多发对其淋巴结转移率的差异。结果经过倾向性评分匹配,两组在CT的Avr值(P=0.001)、KI-67表达水平(P<0.001)、PD-L1表达水平(P=0.002)及淋巴结转移率(P=0.030)上差异有统计学意义,但在结节类型、影像学特征(分叶征、血管集束征等)、肿瘤血清学指标(CEA、NSE等)、ALK阳性率和SYN阳性率上差异均无统计学意义。筛选有显著差异的变量(Avr、Ki-67、PD-L1),经Spearman法检验发现存在相关性。以是否发生淋巴结转移为因变量,纳入单发或多发作为分类协变量、交互纳入以上3个相关性显著的变量为自变量进行二元logistic回归分析,发现多原发腺癌结节较单发腺癌结节发生淋巴结转移的概率低80.8%(RR=0.192,P=0.042)。结论多原发腺癌结节较单发腺癌结节生物学行为较温和,发生淋巴结转移的概率较低;对于多原发肺腺癌结节,应基于术中冰冻病理及影像学等综合评估,制定个性化的治疗方案。

Objective To investigate the clinical characteristics and risk of lymph node metastasis in patients with multiple primary lung adenocarcinoma nodules compared to those with a single lung adenocarcinoma nodule.Methods Retrospective analysis was conducted on 212 patients who underwent thoracic surgery at Zhujiang Hospital of Southern Medical University from 2022 to 2023.This included 149 cases of single lung adenocarcinoma nodules and 63 cases of multiple primary lung adenocarcinoma nodules.After propensity score matching,a comparison was made between the two groups in terms of imaging features,tumor serological indicators,pathological immunohis-tochemistry,and lymph node metastasis rate.Additionally,binary logistic regression was employed to explore the differences in lymph node metastasis rate between single and multiple nodules.Results After propensity score matching,statistically significant differences were observed in the Avr value of CT(P=0.001),KI-67 expression level(P<0.001),PD-L1 expression level(P=0.002),and lymph node metastasis rate(P=0.030)between the two groups.However,there were no statistically significant differences in nodule type,imaging features such as lobula-tion and vascular clustering,tumor serological indicators including CEA and NSE,ALK positive rate,and SYN posi-tive rate.The variables with significant differences(Avr,Ki-67,PD-L1)were identified through Spearman test for correlation analysis.Binary logistic regression analysis was performed using lymph node metastasis as the dependent variable and single or multiple nodules as categorical covariates along with the three correlated variables included as independent variables interactively.The results showed that the probability of lymph node metastasis in multiple primary lung adenocarcinoma nodules was 80.8%lower than that in single lung adenocarcinoma nodules(RR=0.192,P=0.042).Conclusions Multiple primary adenocarcinoma nodules exhibit a less aggressive biological behavior compared to solitary adenocarcinoma nodules,resulting in a reduced likelihood of lymph node metastasis.For cases involving multiple primary lung adenocarcinoma nodules,the implementation of aggressive surgical protocols is not advisable;instead,personalized treatment plans should be developed based on comprehensive evaluations including intraoperative frozen pathology and imaging.