摘要
目的探讨≤10 mm纯磨玻璃密度结节(p GGN)进展的危险因素,拟定≤10 mm p GGN进展的风险分层策略,以提出合理的随访计划。方法回顾性分析2008年6月至2015年4月随访时间超过1年的最大径≤10 mm的100例p GGN患者(108个病灶)的临床资料及CT图像。比较进展组(病灶增大或/和出现实性成分)与未进展组患者的临床资料及病灶的CT征象;应用Cox回归分析患者临床资料及CT表现与病变进展的关系;根据Cox回归分析结果及文献报道的对肺腺癌相关因素的界定,计算病变进展的风险指数;应用Logistic回归分析风险指数与病变进展的关系,绘制风险指数的受试者工作特征曲线,求得风险指数的界值,检验风险指数预测病变进展的效度。结果 100例(108个病灶)患者中有15例(15个病灶)出现进展,所有病灶平均随访时间为(1016.36±486.00)d;单因素分析显示,进展组与未进展组病变的大小、空气支气管征和血管改变的差异具有统计学意义(P=0.040,P=0.003,P=0.030);Cox回归模型显示病变的密度(CT值≥-542.5 HU)和空气支气管征为病变进展的危险因素(P=0.003,P=0.021);预测病变进展的风险指数的界值为4.25(灵敏度为46.7%、特异度为89.2%、符合率为83.3%)。结论对于长期存在≤10 mm的p GGN,病灶密度≥-542.5 HU和空气支气管征的出现可以预测病变的进展;风险指数<4.25提示病变进展的可能性较小,可以适当延长随访时间间隔。
Objective To explore the risk factors of the progression of persistent pure ground-glass nodule（ p GGN） and make the risk stratification for p GGN 10 mm or less in diameter. Methods From June2008 to April 2015,100 patients（ 108 lesions） with persistent p GGN≤10 mm in diameter were included in this study. Patients were followed up at least 1 year using thin-section computed tomography（ CT）. Patients＇ baseline clinical data and CT characteristics of p GGN were compared between progression group（ size increased or/and solid component appeared） and non-progression group. Cox regression analysis was used to assess the relationship between clinical data,CT characteristics of p GGN,and lesion progression. The risk indices of lesion progression were calculated according to the results of Cox regression analysis and the relative factors of lung adenocarcinoma in previous studies. Logistic regression analysis was used to assess the relationship between risk indices and lesion progression. The optimal cutoff value was decided on receiver operating characteristic curve of risk indices and verified for predicting lesion progression. Results Fifteen of 108 lesions showed progression. The mean follow-up duration was（ 1016. 36 ± 486. 00） days. There were statistically significant differences of lesion size,air bronchogram,and vessel changes between progression group and non-progression group（ P = 0. 040,P = 0. 003,P = 0. 030,respectively）. Lesion density（ CT value≥- 542. 5 HU） and air bronchogram were the risk factors of lesion progression（ P = 0. 003,P = 0. 021,respectively）. The optimal cutoff value of total risk indices on predicting lesion progression was 4. 25,with the sensitivity of 46. 7 %,specificity of 89. 2 %,and consistency of 83. 3 %. Conclusions CT value ≥- 542. 5 HU of p GGN and air bronchogram within lesion may predict lesion progression in persistent p GGN 10 mm or less in diameter. A risk index of less than 4. 25 often suggests small probability of disease progression and thus a longer follow-up interval is recommended.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2016年第4期371-377,共7页
Acta Academiae Medicinae Sinicae
关键词
纯磨玻璃密度结节
肺肿瘤
腺癌
随访研究
计算机断层成像
pure ground-glass nodule
lung neoplasms
adenocarcinoma
follow-up studies
tomography
X-ray computed
