Radiomics-based predictive risk score: A scoring system for preoperatively predicting risk of lymph node metastasis in patients with resectable non-small cell lung cancer

Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.

Perioperative considerations in patients with non small cell lung cancer and metastases in mediastinal lymph nodes

Since the latest revision of the TNM system reclassified T3N0 tumours into the ⅡB stage, N2 lesions became the major determinant of the ⅢA stage. Concerning the minority of patients with T3N1 tumours in this stage,

In Surgical Treatment of Non-Small-Cell Lung Cancer a Minimum Number of Resected Mediastinal Lymph Nodes Is Mandatory for Accurate Staging

Objective: Increased numbers of removed lymph nodes (LN) are resulting in more accurate staging of the patient (Will-Rogers-Phenomenon). This study evaluates dependence of lymph node sample size to 1) Will-Rogers-Phenomenom, 2) influence of sample size on overall survival and in?terms of 3) morbidity and mortality. Methods: 131 patients after pulmonary resection were?retrospectively analysed concerning surgery, number of removed lymph nodes, stage, complications and survival. Patients were stratified according to the median number of lymph nodes in two groups (A <12 lymph nodes and B ≥12 lymph nodes). Results: 5% of the patients had only local lymphadenectomy and in 14% a systematic lymphadenectomy was performed. 17% of the patients showed skip metastasis. Lymph node positivity was correlated to the number of removed lymph nodes (p = 0.003). The approximated median survival for UICC (Union internationale contre le cancer) stage I was 511, stage II 521 and stage III 290 days. Subgroup analysis of survival data showed in group A an approximated median survival at stage I of 495 days, at II 537 days and at III 451.5 days. Group B showed at stage I 675 days, at II 521 days and at III 221 days. There was no difference in complications and mortality. Conclusion: A too low sample size leads to understaging due to skip metastasis. Obligatory mediastinal lymph node sampling would decrease the risk of understaging due to skip metastasis and does not increase morbidity or complications. Lymph node sampling is not inferior concerning morbidity and survival in our patient collective. This study cannot recommend a minimum number of LN to be resected. The evaluated limit of 12 LN proves to be suitable as a guideline.

Current status of Radiologic Diagnosis for Mediastinal Lymph Node Metastases of Non-Small-Cell Lung Cancer: Retrospective Study of pN2 Cases

Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small-cell lung cancer (NSCLC), but surgical staging remains the “gold standard” for diagnosis. A proper understanding of the current accuracy of diagnostic imaging is needed for further improvements. Methods: Forty-three patients who underwent resection for NSCLC involving mediastinal lymph node (MLN) metastasis at our hospital between June 2003 and May 2011 were enrolled in this study. We conducted a retrospective study of the radiological and pathological findings for 53 metastatic MLNs in the 43 patients. Results: The preoperative imaging modality was computed tomography (CT) alone for 18 patients (22 MLNs) and CT and FDG-PET for 25 patients (31 MLNs). The sensitivities of CT and FDG-PET were 41.5% and 58.0%, respectively. The sensitivity of CT did not differ according to any clinicopathological factors, but the sensitivity of FDG-PET tended to be higher for primary tumors with high SUVmax values and for non-adenocarcinomas. In the lymph nodes, all micrometastatic foci ≤ 2 mm were PET-negative, but 4 lymph nodes with metastatic foci larger than 10 mm were also PET-negative. Conclusions: For the diagnostic imaging of MLN, FDG-PET has a greater sensitivity than contrast-enhanced CT based on “size criteria”, but it is still not sufficiently sensitive and is influenced by various factors. At present, histological confirmation of MLNs is necessary when making decisions regarding treatment plans and the type of surgical procedure that should be performed.

PTEN and Ki67 expression is associated with clinicopathologic features of non-small cell lung cancer

Phosphatase and tensin homolog deleted on chromosome 10（PTEN） and the proliferating antigen Ki67 have been widely studied in several tumors.However,their role as indicator in non-small cell lung cancer（NSCLC）remains unknown.Here,we investigated the expression of PTEN and Ki67 in NSCLC tissues and paired normal lung tissues to identify whether these proteins are associated with lung cancer development and survival.Immunohistochemistry for PTEN and Ki67 was performed on 67 lung cancer tissues and 41 paired adjacent normal lung tissues to detect the expression of these two proteins.The expression of PTEN in NSCLC tissues（32.8%） was significantly lower than that in normal tissues（82.9%,P 〈 0.05）.In contrast,the expression of Ki67 in NSCLC tissues（76.1%） was significantly higher than that in normal tissues（27.3%,P 〈 0.05）.Expression of both PTEN and Ki67 were strongly associated with tumor histology,clinical stage,lymph node metastasis,differentiation and4-year postoperative survival rate（P 〈 0.05）.However,PTEN expression was negatively correlated with Ki67 expression（r =-0.279,P 〈 0.05）.In conclusion,low PTEN expression and Ki67 overexpression are associated with malignant invasion and lymph node metastasis of NSCLC.These proteins may serve as diagnostic and prognostic biomarkers of NSCLC.

Expressions of Livin and Smac Proteins in Non-Small Cell Lung Cancer

Objective： To investigate the expression characteristics of Livin and second mitochondrial activator of Caspase （Smac） proteins in non-small cell lung cancer （NSCLC）, and analyze their effect on patients＇ prognosis. Methods： The expressions of Livin and Smac proteins were detected in 89 NSCLC tissue samples and 25 normal lung tissue samples by immunohistochemical technique. Results： The positive expression rates of Livin and Smac proteins in NSCLC tissues were 53.9%, and 58.4% respectively, higher than that in normal lung tissues（P〈0.01）. Livin protein expression correlated with Smac protein significantly（Χ^2=1 8.451, P=0.000, r=0.455）. The expression level of Livin protein was closely related to lymph node metastasis, TNM stage and histological type （P〈0.05）, but not to sex, age, differentiation grade （P〉0.05）. The expression level of Smac protein was closely related to lymph node metastasis, TNM stage （P〈0.01）, but not to sex, age, histological types （P〉0.05）. Kaplan-Meier analysis revealed a significant impact on survival by Livin protein in NSCLC （P〈0.01）, but not by Smac protein （P〉0.05）. Conclusion： Overexpression of Livin protein may play a promoting role in the occurrence and progression of NSCLC. Moreover, it may bring an adverse effect on patients＇ prognosis. Although overexpression of Smac protein affects the occurrence and progression of NSCLC, it has no relationship with the prognosis. Livin protein may be helpful to evaluate the progression of NSCLC, and to predict the prognosis.

Clinical pathology of nodal micrometasteses in non-small cell lung cancer

Objective:To explore whether the conventional pathologic stages of some non-small cell lung cancer (NSCLC) patients were underestimated.Methods:195 lymph node samples were taken from 25 NSCLC patients during the operations.Firstly,each resulting tissue block was processed for routine paraffin embedding.Then the 6～10 serial sections were chosen,each 5 μm thick,from every paraffin block of the lymph node.Finally,the first and the second last sections of each lymph node were stained by hematoxylin eosin (HE),and the other serial sections were used for the immunohistochemical (IHC) staining examination with the monoclonal antibody against cyokeratin 19.Results:With HE staining,30 of the 195 regional lymph nodes revealed dominant nodal metastases,and none showed micrometastases.IHC staining was performed on 135 lymph nodes that were identified as free of metastases by HE staining,31 showed micrometastases;none showed gross nodal metastases.There was a significant difference between HE staining staging and IHC staining staging (P<0.05).Conclusion:Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of NSCLC patients,but is unfit for detecting lymph nodal micrometastases.IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes,and its assessment of nodal micrometastases can provide a refinement of TNM stage for NSCLC patients.Our results provide a rationale for extensive lymph nodes sampling.

LungPoint导航联合吲哚菁绿荧光成像在Ⅰa期非小细胞肺癌淋巴结采样中的应用价值

目的:寻找一种准确定位Ⅰa期非小细胞肺癌患者(NSCLC)前哨淋巴结(SLN)的方法,验证SLN作为淋巴结取样样本的合理性。方法:采用前瞻性研究方法,参照入组标准纳入2021年1月至2023年12月在山东省公共卫生临床中心胸外科临床分期为Ⅰa期NSCLC住院患者50例,术前借助LungPoint导航气管镜下肿瘤周围注射示踪剂吲哚菁绿,通过荧光胸腔镜成像完成SLN定位,并对包括SLN在内的区域淋巴结行病理学检查,使用该方法对SLN的识别率、准确率与假阴性率等验证其作为淋巴结取样样本的合理性。结果:50例患者中,41例检测到SLN,识别率为82.0%(41/50),经病理检测发现3例共计9枚SLN有淋巴结转移(阳性),其中1例亦检出非前哨淋巴结(N-SLN)阳性2枚。9例患者未检测到SLN,清扫淋巴结54枚,未发现转移淋巴结,故SLN准确率为100.0%(41/41),假阴性率为0(0/3)。结论:借助LungPoint气管镜在肿瘤周围注射示踪剂吲哚菁绿,通过荧光胸腔镜成像探寻SLN技术具有较高的区域淋巴结转移预测性,有望成为指导Ⅰa期NSCLC系统性淋巴结采样的依据。

Extrapulmonary small cell carcinoma of lymph node: Pooled analysis of all reported cases

AIM: To study clinical outcomes and management of lymph nodes extrapulmonary small cell carcinoma(LNEPSCC). METHODS: Herein, we perform a systematic search of published literature in the PubMed and EMBASE databases for studies describing LNEPSCC. For uniformity of reporting, LNEPSCC was staged as limited if it involved either single lymph node station or if surgery with curative intent had been undertaken. The disease was staged extensive if it involved two or more lymph node regions.RESULTS: The systematic literature review yielded eight descriptions(n = 14) involving cervical, submandibular and inguinal lymph nodes. Eleven(64.7%) patients had limited disease(LD) and six(35.3%) had extensive disease(ED) at presentation. Chemotherapy(n = 6, 35.3%) or surgery(n = 4, 23.5%) were the most common form of treatment given to these patients. Complete response was achieved in 12(70.6%) of the patients. Median(interquartile range) progression free survival and overall survival was 15(7-42) mo and 22(12.75-42) mo respectively. Of the three illustrative cases, two patients each had ED at presentation and achieved complete remission with platinum based combination chemotherapy.CONCLUSION: LNEPSCC is a rare disease with less than 15 reported cases in world literature. Surgical resection with curative intent is feasible in those with LD while platinum based combination chemoradiation is associated with favorable outcomes in patients with ED. Prognosis of LNEPSCC is better than that of small cell lung cancer in general.

Accuracy of ^18F-FDG PET/CT for lymph node staging in non-small-cell lung cancers

Background This retrospective study evaluated the diagnostic accuracy of 2-（F18）-fluoro-2-deoxy-D-glucose-positron emission tomography （^18F-FDG-PET）/computed tomography （PET/CT） in the preoperative diagnosis of metastatic mediastinal and hilar lymph node in patients with non-small-cell lung cancer （NSCLC）. Methods A total of 39 patients received preoperative ^18F-FDG PET/CT and the postoperative biopsy. We compared preoperative PET/CT scan results with corresponding intraoperative histopathalogic findings in 39 NSCLC patients. The sensitivity, specificity, accuracy, positive and negative predictive value of ^18F-FDG PET/CT were assessed. Results Histopathologic examination confirmed metastasis in 57 out of the 208 excised lymph nodes; 23 of the 57 nodes were mediastinal and hilar lymph nodes. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT in the preoperative diagnosis of mediastinal lymph node metastasis in NSCLC patients were 65%, 96.8%, 92%, 78.5% and 90%, respectively. Conclusions PET/CT scan showed good accuracy in the preoperative diagnosis of mediastinal and hilar lymph node metastasis in the patients with NSCLC. We recommend that PET/CT scanning be used as a first-line evaluation tool for tumor diagnosis, therapy evaluation and follow-up.

Integrated positron emission tomography and computed tomography in preoperative lymph node staging of non-small cell lung cancer

Background Integrated positron emission tomography and computed tomography （PET/CT） is increasingly used for the preoperative nodal staging of non-smail cell lung cancer （NSCLC）.The aim of this study was to evaluate the accuracy of PET/CT in comparison with CT in detection of nodal metastasis and preoperative nodal staging in patients with NSCLC,and to analyze the causes of the PET/CT false-negative and false-positive results.Methods Consecutive patients with pathologically proven NSCLC who underwent staging using PET/CT from July 2008 to February 2012 were evaluated retrospectively.Nodal staging was pathologically confirmed on tissue specimens obtained at thoracotomy.The accuracy of PET/CT and CT in the assessment of intrathoracic nodal involvement was determined using histological results as the reference standard.Logistic regression was used to define the causes of the false-negative and false-positive results.Results A total of 528 lymph node stations were evaluated in 101 patients.Lymph nodes were positive for malignancy in 43 out of 101 patients （42.6%）,and 101 out of 528 nodal stations （19.2%）.PET/CT was significantly more accurate for nodal staging than CT.The sensitivity,specificity,positive and negative predictive values,and accuracy of PET/CT for detecting nodal metastasis were 51.5%,95.8%,74.3%,89.3%,and 87.3% and the corresponding data by CT were 45.5%,87.1%,45.5%,87.1%,and 79.2%,respectively.PET/CT confers significantly higher specificity,positive predictive value,and accuracy than CT in detecting nodal metastasis.False-negative results by PET/CT are significantly associated with smaller lymph node size,whereas false-positive results are related to a combination of inflammatory disorders and larger lymph node size.Conclusion PET/CT confers significantly higher accuracy than CT in nodal staging,and is more specific and accurate than CT in detecting nodal metastasis but has a low sensitivity and high false-negative rate.

术前多排螺旋CT三期增强扫描对非小细胞肺癌纵隔淋巴结转移的诊断价值

目的探讨多排螺旋CT(MSCT)三期增强扫描对非小细胞肺癌(NSCLC)纵隔淋巴结转移(MLNM)中的术前诊断价值。方法回顾性分析80例NSCLC患者的临床资料,术前均行MSCT三期增强扫描,以术后病理结果为金标准,使用Kappa一致性检验评价MSCT三期增强扫描在术前诊断MLNM的诊断效能。结果术后病理检查证实80例NSCLC患者中,N0期31例,N1期24例,N2期25例,其中MLNM 25例(31.25%);术前MSCT诊断N0期34例,N1期24例,N2期22例,术前MSCT对NSCLC患者N分期诊断与术后病理一致性一般(Kappa=0.735);25例合并MLNM患者中,术前MSCT确诊19例,其对NSCLC患者MLNM的诊断与病理结果一致性一般(Kappa=0.531),其诊断的灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为76.00%、80.00%、78.75%、63.33%和88.00%;纵隔淋巴结转移率在不同肿瘤直径、胸膜凹陷与否、不同肿大淋巴结位置、累及粗大肺静脉与否以及不同淋巴结短径的NSCLC患者间比较均有统计学意义(P<0.05)。结论术前MSCT三期增强扫描诊断NSCLC患者MLNM具有一定的准确性,结合原发病灶大小、胸膜凹陷、肿大淋巴结位置、累及粗大肺静脉等多方面信息可为淋巴结清扫提供重要参考。

多模态MRI影像组学对非小细胞肺癌纵隔淋巴结转移的预测价值

目的建立基于常规MRI序列的影像组学模型,比较不同模型预测非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移的效能。材料与方法回顾性分析2012年10月至2022年5月南通市第一人民医院90例NSCLC患者的术前MRI数据,根据手术病理结果分为淋巴结转移阳性组(52例)和阴性组(38例),采用完全随机法按照7∶3比例将患者分为训练集和测试集,盐城第一人民医院的31例患者数据作为外部验证(阳性9例,阴性22例),放射科医师半自动逐层勾画原发病灶,提取基于T1WI、T2WI、高b值弥散加权成像(diffusion weighted imaging,DWI)、表观扩散系数(apparent diffusion coefficient,ADC)图像的组学特征,由超参数搜索在单因素方差分析、L1正则化、树模型等特征筛选法中选择最佳方法用于降维,分别建立逻辑斯特回归(logistic regression,LR)、高斯朴素贝叶斯(Gaussian naive Bayes,Gaussian NB)、随机森林(random forest,RF)、支持向量机(support vector machine,SVM)、决策树(decision tree,DT)等11种模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线来评估模型的性能。结果在不同序列中DT、LR、SVM模型的预测性能都表现良好,其中基于T2WI图像构建的SVM模型效能最佳,训练集、测试集及外部验证集曲线下面积(area under the curve,AUC)分别达0.98、0.98、0.72,准确度分别为96%、67%、61%、敏感度分别为88%、67%、55%、特异度分别为100%、67%、78%。结论MRI影像组学可帮助识别NSCLC患者纵隔淋巴结是否转移,以基于T2WI的SVM模型表现最优。

右侧3a组淋巴结转移特点及其对非小细胞肺癌手术切除的影响

目的:探讨右侧3a组淋巴结转移特点,分析其对非小细胞肺癌手术切除的影响。方法:通过回顾性分析2015年6月—2023年1月于苏州大学附属第一医院胸外科及苏州大学附属第四医院胸心大血管外科行右侧肺癌手术切除及系统性淋巴结清扫术共180例患者,术后病理均为非小细胞肺癌。归纳患者的各项临床资料及淋巴结转移特点。结果:3a组淋巴结阳性率为11.67%。单因素分析表明3a组淋巴结阳性组在病灶直径、病灶位置(右上叶)占比与阴性组相比均较高,差异均有统计学意义(P<0.05)。多因素分析表明病灶直径,病灶位置(右上叶)为3a组淋巴结发生转移的独立危险因素。受试者操作特征(ROC)曲线分析对病灶直径进行分析显示2.5 cm为临界值。当病灶直径>2.5 cm,3a组淋巴结转移率明显升高(P=0.001)。结论:右侧3a组淋巴结转移率也值得关注,手术过程中也应重视给予清扫。当病灶直径>2.5cm位于右上叶的非小细胞肺癌,则更应重视3a组淋巴结切除。

基于^(18)F-FDG PET/CT影像组学分析不同机器学习模型预测非小细胞肺癌隐匿性淋巴结转移的价值

目的探讨基于治疗前18氟-脱氧葡萄糖(^(18)F-FDG)正电子发射断层显像术(PET)/CT影像组学预测非小细胞肺癌(NSCLC)患者隐匿性淋巴结转移(OLM)的价值,分析不同机器学习模型对预测结果的影响。方法回顾性选取2019年1月至2023年5月于宁波明州医院行^(18)F-FDG PET/CT检查并行根治性手术及系统性淋巴结清扫的NSCLC患者324例(男186例,女138例,年龄36~85岁),其中OLM阴性258例,阳性66例。采用随机数字表法按7:3比例将患者分为训练集(226例)与验证集(98例)。使用LIFEx 7.4.3软件提取病灶PET/CT影像组学特征,采用最小绝对收缩与选择算子(LASSO)算法进行特征筛选,构建3种机器学习模型:逻辑回归(LR)模型、支持向量机(SVM)模型、随机森林(RF)模型。采用ROC曲线分析评估各种模型的预测效能,并采用决策曲线(DCA)分析各种模型的临床价值。结果从PET/CT图像中共提取出250个影像组学特征,经LASSO算法最终筛选出8个组学特征,包括4个PET特征[直方图(HISTO)_均匀性(Uniformity)、灰度共生矩阵(GL-CM)_差熵(DE)、灰度游程长度矩阵(GLRLM)_短行程低灰度强调(SRLGLE)、灰度区域大小矩阵(GLSZM)_小区域低灰度强调(SZLGLE)],4个CT特征[形态(MORPH)_质量中心偏移(CMS)、HISTO_四分位离散系数(QCD)、HISTO_最大直方图梯度(MHG)、GLSZM_大区域强调(LZE)]。在构建的3种机器学习模型中,以SVM模型预测效能最优,其在训练集及验证集中的AUC分别为0.846、0.849;LR模型在训练集与验证集中的AUC分别为0.696、0.711;RF模型在训练集与验证集中的AUC分别为0.943、0.568,存在明显的过拟合现象。DCA分析显示,SVM模型及LR模型均具有较好的净获益与临床价值。结论基于^(18)F-FDG PET/CT影像组学分析可有效预测NSCLC患者是否存在OLM,SVM模型预测性能最佳,可辅助临床决策及制定个性化治疗方案。

Tis~T1期非小细胞肺癌脏层胸膜受累与淋巴结转移的相关性

目的探讨Tis~T1期非小细胞肺癌(NSCLC)脏层胸膜受累情况与淋巴结转移的相关性。方法回顾性分析84例Tis~T1期NSCLC患者的临床资料。所有患者均行肺叶切除术+系统性淋巴结清扫术治疗,术后将病理标本送检,明确患者胸膜脏层浸润(VPI)状态,依据VPI分为分为PL0组与PL1/PL2组。收集两组患者年龄、性别、体质量指数、基础疾病、肿瘤大小、病理类型、肿瘤位置、脉管瘤栓、术前癌胚抗原(CEA)水平、基础疾病及淋巴结转移情况等资料。分析VPI与临床病理特征及淋巴结转移的关系。结果84例患者中18例合并VPI,脏层胸膜受累率为21.43%(18/84);PL1/PL2组肿瘤大小2~3 cm、术前CEA水平≥3.5 ng/L占比高于PL0组,差异有统计学意义(P<0.05);PL1/PL2组淋巴结转移率、N2比率高于PL0组,差异有统计学意义(P<0.05)。结论Tis~T1期NSCLC患者VPI与淋巴结转移存在密切关系,当合并VPI时则需考虑存在淋巴结转移,术中应予以广泛淋巴结清扫,避免术后复发转移。

^(18)F-氟代脱氧葡萄糖正电子发射断层扫描成像/CT原发灶影像特征对非小细胞肺癌淋巴结转移的预测价值

目的 基于^(18)F-氟代脱氧葡萄糖(^(18)F-FDG)正电子发射断层扫描成像/CT(PET/CT)探究非小细胞肺癌(NSCLC)淋巴结转移的影响因素,建立Logistic预测模型并分析其预测临床价值。方法 收集我院收治的NSCLC患者156例为观察对象,纳入年限为2019年6月至2021年6月,根据是否合并淋巴结转移分为合并淋巴结转移组47例和未合并淋巴结转移组109例,比较2组临床病理特征,均行^(18)F-FDG PET/CT检查,比较2组患者区域最大标准摄取值(SUVmax)、糖酵解总量(TLG)、代谢体积(MTV)等原发灶影像学特征,并建立Logistic回归方程:P=ExpΣBiXi/1+ExpΣBiXi,建立Logistic预测模型并分析其预测淋巴结转移的灵敏度、特异度和准确度。结果 淋巴结转移组TNM分期Ⅲ期及肿瘤直径≥3 cm比例高于无淋巴结转移组(P<0.05)。淋巴结转移组患者原发灶T-SUVmax、T-TLG、L-SURmax、T-TLGsur、B-SURmax、B-TLGsur指标均高于无淋巴结转移组,差异具有统计学意义(P<0.05)。Logistic回归分析结果提示TNM分期、肿瘤直径、T-SUVmax、T-TLG、L-SURmax、T-TLGsur、B-SURmax、B-TLGsur指标均与NSCLC淋巴结转移有关(P<0.05)。通过Logistic回归模型预测NSCLC发生淋巴结转移的概率P,建立P值的受试者工作特征(ROC)曲线,模型预测概率P的曲线下面积(AUC)为0.796(0.693~0.899),提示该模型具有较高的效用价值。当灵敏度为89.5%,特异度为69.0%,约登指数为0.585,对应的预测概率为-3.258。结论 NSCLC淋巴结转移的原发病灶18FFDG PET/CT影像特征明显异常表达,建立预测模型可进一步提高NSCLC患者淋巴结转移的诊断效能,临床上可以选择更加积极的治疗方案。

早期孤立性肺腺癌患者淋巴结转移风险因素及与PET-CT摄取的关系研究

目的 探讨早期孤立性肺腺癌患者淋巴结转移(LNM)风险因素及与正电子发射断层成像-X线计算机断层成像(PET-CT)摄取的关系。方法 纳入2015年1月至2021年9月于我院行手术治疗临床组织分期(cT)1期孤立性肺腺癌患者共251例,根据病理淋巴结(pN)分期划分为NO组(225例)、N1组(16例)及N2组(10例),分析临床病理资料及术前薄层CT检查资料,采用多因素Logistic回归模型评价患者LNM发生独立危险因素及与最大标准摄取值(SUVmax)的相关性。结果 单因素分析结果 显示,病灶最大径、磨玻璃结节类型、血CEA水平及腺癌病理组织学类型均与早期孤立性肺腺癌患者LNM发生有关(P<0.05);多因素Logistic回归模型分析结果 显示,混合型磨玻璃结节、实性磨玻璃结节、血CEA水平>5ng/mL、腺泡型肺腺癌、乳头状/微乳头状浸润型肺腺癌及实体型肺腺癌均是早期孤立性肺腺癌患者LNM发生独立危险因素(P<0.05)。单因素分析结果 显示,早期孤立性肺腺癌患者LNM发生与SUVmax有关(P<0.05);多因素Logistic回归模型分析结果 显示,SUVmax>5是早期孤立性肺腺癌患者LNM发生独立危险因素(OR=3.42,95%CI:1.40~10.68,P=0.00)。结论 早期孤立性肺腺癌患者LNM发生与磨玻璃结、血CEA水平及病理组织学类型关系密切;同时PET-CT检查SUVmax>5者更易出现淋巴结转移。

双期^(18)F-FDG PET/CT原发灶影像组学对非小细胞肺癌淋巴结转移的预测价值

目的探讨双期^(18)F-FDG PET/CT原发灶影像组学特征对非小细胞肺癌(NSCLC)淋巴结转移的预测价值。方法收集我院经手术病理证实为NSCLC并明确有无淋巴结转移的101例患者的术前双期^(18)F-FDG PET图像,自动勾画并提取原发灶常规及延迟显像影像组学特征各117个。按常规显像模式(a)、延迟显像模式(b)及常规+延迟显像模式(c)分别构建影像组学模型,采用t检验与LASSO回归筛选最优子集模型,建立支持向量机(SVM)模型与受试者工作特征(ROC)曲线,Delong检验不同模型曲线下面积(AUC)差异。结果常规+延迟显像模式(c)影像组学模型对淋巴结转移的预测效能最优,其灵敏度、特异度、AUC、训练组预测准确率、测试组预测准确率分别为88.06%、94.12%、0.967、92.86%和80.65%,高于常规显像模式(a)的86.57%、79.41%、0.882、80.00%和70.97%和延迟显像模式(b)的80.60%、88.24%、0.872、85.71%和70.97%(a vs.b Z=0.202,P=0.8399;a vs.c Z=2.385,P=0.0171;b vs.c Z=2.273,P=0.0230)。结论双期^(18)F-FDG PET/CT原发灶影像组学特征模型可用于预测NSCLC淋巴结转移,可指导临床治疗和预后判断。

pN0期非小细胞肺癌VEGF、Ki-67、p53表达与淋巴结微转移的相关性

目的:探讨pN0期非小细胞肺癌血管内皮生长因子(VEGF)、Ki-67、p53表达与淋巴结微转移相关性。方法:选择术后经常规病理检查证实为pN0期的非小细胞肺癌病人93例及手术治疗的非肺癌病人45例,采用免疫组织化学法检测肺癌组织及正常肺组织中VEGF、Ki-67和p53表达情况,分析肺癌组织中VEGF、Ki-67、p53表达与病人临床病理学特征的关系,并采用ROC曲线分析其对淋巴结微转移的诊断价值。结果:肺癌组织中VEGF、Ki-67和p53表达阳性率均明显高于正常肺组织(P<0.01)。不同TNM分期的非小细胞肺癌病人肺组织VEGF、Ki-67、p53表达阳性率差异均有统计学意义(P<0.05),而不同性别、年龄、病理类型、肿瘤最大径及吸烟史病人的VEGF、Ki-67、p53表达阳性率差异均无统计学意义(P>0.05)。淋巴结微转移的非小细胞肺癌病人VEGF、Ki-67、p53表达评分均明显高于无淋巴微转移病人(P<0.01)。VEGF、Ki-67、p53评分对非小细胞肺癌病人淋巴结微转移诊断AUC分别为0.816、0.877、0.821。结论:pN0期非小细胞肺癌病人肺组织VEGF、Ki-67及p53表达与肺癌的发生发展有关,且与病人淋巴结微转移有关,可作为病人淋巴结微转移的潜在检测指标。