周围型非小细胞肺癌CT影像学因素预后分析

目的探讨周围型非小细胞肺癌(NSCLCs)术前胸部CT影像学因素与预后的关系。方法回顾性收集周围型NSCLCs患者187例,对5例行平扫CT,182例行平扫+增强CT。由2名医师盲法独立阅片,记录肿瘤大小、肿瘤密度、空洞、毛刺、胸膜凹陷、与邻近结构接触面长度及临床N分期。采用Kaplan-Meier曲线及COX回归模型进行生存分析。结果 57例患者死亡,中位随访时间53个月(4~103个月)。Kaplan-Meier单因素分析结果显示:肿瘤大小(P0.001)、肿瘤密度(P=0.027)、空洞(P=0.013)、毛刺(P=0.004)、与邻近结构接触面长度(P=0.029)、临床N分期(P0.001)、血清CEA水平(P0.001)差异有统计学意义。COX多因素分析显示:临床N分期(P0.001,HR=3.617)、肿瘤大小(P=0.001,HR=2.885)、毛刺(P=0.003,HR=2.505)是周围型NSCLCs独立的预后因素。结论术前胸部CT显示临床N分期、肿瘤大小、毛刺是周围型NSCLCs的独立预后因素。

Prognostic analysis of CT findings in peripheral non-small cell lung cancers

Objective To evaluate the prognostic value of preoperative chest CT findings of peripheral non-small cell lung cancers (NSCLCs). Methods Totally 187 patients with peripheral NSCLCs were retrospectively investigated, 5 cases underwent plain CT scan, 182 cases underwent enhanced CT scan. CT images were reviewed by 2 radiologists blindly. Tumor size, attenuation, cavitation, spiculation, pleural indentation, the length of the interface between tumor and neighboring structures and clinical N staging were recorded. The prognostic factors were analyzed by Kaplan-Meier method and COX proportional hazards regression model. Results Totally 57 patients died, the median time of follow up was 53 months (4-103 months). Univariate analysis revealed tumor size (P<0.001), attenuation (P=0.027), cavitation (P=0.013), speculation (P=0.004), the length of the interface between tumor and neighboring structures (P=0.029), clinical N staging (P<0.001), serum CEA level (P<0.001) were significant prognostic factors of peripheral NSCLCs. Multivariate analyses revealed clinical N staging (P<0.001, HR=3.617), tumor size (P=0.001, HR=2.885), spiculation (P=0.003, HR=2.505) were independent prognostic factors. Conclusion Clinical N staging, tumor size, spiculation shows on preoperative chest CT are independent prognostic factors of peripheral NSCLCs patients.