实性成分≤2 cm的肺腺癌患者淋巴结转移的临床病理学特征及危险因素

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摘要目的总结分析实性成分≤2 cm的肺腺癌患者淋巴结转移的临床病理学特征及危险因素。方法回顾性纳入2018-01至2021-01在解放军总医院第一医学中心胸外科行手术治疗的实性成分≤2 cm的肺腺癌患者资料,分析其临床病理学特征及淋巴结转移危险因素。结果共纳入340例患者,其中淋巴结转移阳性31例(9.1%,阳性组),阴性309例(90.9%,阴性组)。阳性组的术前肿瘤标志物异常占比、结节直径、PET-CT标准摄取值明显高于阴性组[22.6% vs. 4.5%, P<0.001;(17.77±3.11)mm vs.(12.10±5.21)mm,P<0.001;4.83±4.36 vs. 2.53±3.15,P=0.017]。阴性组中的结节更多是亚实性结节(66% vs. 9.7%, P<0.001)且结节更规则并伴有空泡征(25.8% vs. 54%, P=0.008;35.3% vs. 3.2%, P<0.001)。阳性组在淋巴结清扫组数(5.77±1.05 vs. 5.14±1.28,P=0.008)及数目(15.35±6.28 vs. 12.60±7.19, P=0.041)方面均高于阴性组。阳性组有更多的患者出现胸膜侵犯(54.8% vs. 34%, P=0.021)、脉管浸润(9.7% vs. 0, P<0.001)、肺泡腔内播散(9.7% vs. 0.6%,P<0.001)、肿瘤低分化(19.4% vs. 5.5%,P=0.009)及特殊病理亚型肿瘤(含有微乳头或实性成分)(71% vs. 14.2%,P<0.001),且Ki-67指数显著高于阴性组(19.54±13.68 vs. 10.70±14.16,P=0.013)。多因素Logistic回归分析显示肿瘤实性成分大小(OR=1.712,P=0.040)和特殊病理亚型肿瘤(含有微乳头或实性成分) (OR=39.809,P=0.002)是淋巴结转移的独立危险因素。结论实性成分≤2 cm的腺癌患者淋巴结转移率不低,实性成分大小和含有微乳头或实性成分的病理亚型是其发生淋巴结转移的独立危险因素。此类患者仍应行系统性淋巴结清扫,谨慎选择亚肺叶切除术。

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	梁朝阳
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	郭俊唐
	刘阳

关键词 ：肺腺癌, 淋巴结转移, 危险因素

Abstract：Objective To analyze the clinicopathological characteristics and risk factors of lymph node metastasis in lung adenocarcinoma whose solid components in pulmonary nodules are less than 2 centimeters in diameter.Methods The clinicopathological data on 340 patients who had received surgery in the First Medical Center of Chinese PLA General Hospital between January 2018 and January 2021 was analyzed retrospectively. The clinicopathological characteristics and risk factors of lymph node metastasis were analyzed.Results Of these patients, 31 were positive for lymph node metastasis (9.1% in the positive group) and 309 were negative (90.9% in the negative group). The proportion of tumor marker abnormalities, nodule diameters, and PET-CT standard uptake values in the positive group were significantly higher or larger than those in the negative group [22.6% vs. 4.5%, P<0.001; (17.77±3.11) mm vs. (12.10±) 5.21) mm, P<0.001; 4.83±4.36 vs. 2.53±3.15, P=0.017, respectively]. There were more subsolid (66% vs. 9.7%, P<0.001) nodules and regular nodules (25.8% vs. 54%, P=0.008) in the negative group, which also had more vacuoles (35.3% vs. 3.2%, P<0.001). The groups (5.77±1.05 vs. 5.14±1.28, P=0.008) and numbers (15.35±6.28 vs. 12.60±7.19, P=0.041) of lymph node dissections in the positive group surpassed those in the negative group respectively. In the positive group, more patients presented with visceral pleural invasion (54.8% vs. 34%, P=0.021), vascular infiltration (9.7% vs. 0, P<0.001), spread of tumors through air space (9.7% vs. 0.6%, P<0.001), poorly- differentiated tumors (19.4% vs. 5.5%, P=0.009) and tumors of a special pathological subtype (containing micropapillary or solid components) (71% vs. 14.2%, P<0.001), and the Ki-67 index was significantly higher than that in the negative group (19.54±13.68 vs. 10.70±14.16, P=0.013). Multivariate logistic regression analysis showed that the size of solid components (OR=1.712, P=0.040) and tumors of a special pathological subtype (containing micropapillary or solid components) (OR=39.809, P=0.002) were independent risk factors for lymph node metastasis.Conclusions In lung adenocarcinoma patients whose diameter of solid components in pulmonary nodules is less than 2 centimeters, lymph node metastasis is not rare. The diameter of solid components and a special pathological subtype (micropapillary or solid components) are independent risk factors. Systemic lymph node dissection should be performed and sublobectomy should be chosen with caution in such patients.

Key words： lung adenocarcinoma lymph node metastasis risk factor

收稿日期: 2021-06-10

ZTFLH:

R734.2

作者简介: 梁朝阳,博士,主任医师。

引用本文:

梁朝阳, 申磊磊, 云天洋, 郭俊唐, 刘阳. 实性成分≤2 cm的肺腺癌患者淋巴结转移的临床病理学特征及危险因素[J]. 武警医学, 2022, 33(2): 134-139. LIANG Chaoyang, SHEN Leilei, YUN Tianyang, GUO Juntang, LIU Yang. Correlations between lung adenocarcinoma with a less-than-two-centimeter diameter of solid components in pulmonary nodules and lymph node metastasis. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(2): 134-139.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I2/134

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