早期肺腺癌淋巴结转移临床预测因素研究

目的：研究肺腺癌是否因淋巴转移而需进行系统性淋巴清扫并寻找预测因素。方法通过回顾性分析198例外周型小结节的肺腺癌患者发生淋巴结转移的情况,并对患者的临床因素进行分析,记录曾行正电子发射计算机断层显像（ PET-CT）检查患者的最大标准摄入值（ SUVmax）,单因素与多因素进行相应分析,寻找容易使淋巴结转移的临床相关因素。结果34例CT影像学类型为纯磨玻璃影患者中无淋巴结转移,混合型磨玻璃影的72例患者中67例（93.1%）无淋巴结转移,只有5例（6.9%）患者发生淋巴结转移,而表现为实性结节的92例患者中共有29例（31.5%）发生淋巴结转移,P〈0.01,差异有显著性。单因素分析中,肿瘤直径大于1cm,混合性结节及实性结节及CEA〉5μg/L成为重要预测因素。另外通过行PET-CT患者中最大标准摄入值的分析表明,SUVmax〉5时,患者发生淋巴转移的发生率更高,P〈0.05,差异有显著性。对这类患者需要实行淋巴结清扫。结论肺腺癌患者在高分辨CT 纯磨玻璃影的患者淋巴结转移较少。肿瘤直径大于1cm,影像学表现为混合性结节或实性结节,癌胚抗原CEA〉5μg/L,PET-CT检查的SUV-max〉5的情况有淋巴结转移发生,暗示需要进行系统性淋巴结清扫。

Study of clinical predictors of lymph node metastasis of lung adenocarcinoma

Objective To study whether the lymph node metastasis of lung adenocarcinoma and in need of systematic lymph node dissection and to identify predictive factors. Method A retrospective analysis of our hospital 198 cases of peripheral type small nodules in the lung adenocarcinoma patients with lymph node metastasis, and the clinical factors were analyzed, records of patients undergoing PET-CT SUVmax value, the single factor analysis and multi factors, looking for easy to lymph node metastasis related clinical factors. Result The 34 cases of CT imaging types for the pure ground glass shadow at noon in patients with lymph node metastasis, 72 cases of mixed type of ground glass shadows in 67 cases （93. 1%） without lymph node metastasis, only 5 cases （6. 9%） occurred in patients with lymph node metastasis, and performance for the solid nodules in 92 patients with a total of 29 cases （31. 5%） lymph node metastasis, P〈0. 01, significantly, there was statistical significance. In univariate analysis, tumor di-ameter greater than 1cm, mixed nodules and solid nodules and CEA〉5ng/ml became an important predictive factor. By analyzing the maximum standardized uptake value in patients with PET-CT showed that, SUVmax〉5, patients have higher incidence of lymph node metastasis, P〈0. 05, significant difference, there was statistical significance. To this kind of patient needs a lymph node dissection. Conclusion Patients with adenocarcinoma of the lung with lymph in high resolution CT pure ground glass shadow node metastasis is less, the tumor diameter greater than 1cm, imaging uptake value for mixed nodules or solid nodules, carcinoembryonic antigen CEA〉5ng/ml, PET-CT （SUV-max） standard 〉5 with lymph node metastasis occurred, suggesting a need systematic lymph node dissection.