摘要
目的分析胸腺上皮肿瘤(TETs)TNM分期(第9版)与临床、CT特征及组织病理分型的相关性。方法回顾性收集165例经手术病理确诊为TETs患者的临床、CT特征,按照TETs第9版TNM分期分为早期(Ⅰ、Ⅱ期)、晚期(Ⅲ、Ⅳ期),根据WHO组织病理分型简化为低风险组(A型、AB型和B1型)、高风险组(B2型和B3型)和胸腺癌组,分析TNM分期与临床、CT特征及组织病理分型的相关性,计数资料采用χ2检验,计量资料采用方差分析或K-W非参数检验。结果I期多无症状(41.4%),Ⅳ期多表现为胸痛(37.5%)及咳嗽(31.2%)。重症肌无力在Ⅱ期(27.2%)和Ⅲ期(23%)多见,在Ⅳ期(4.2%)最少见。TNM分期与WHO简化病理分型有中等正相关,相关性具有统计学意义。Ⅱ、Ⅲ、Ⅳ期多为形态不规则和分叶状,Ⅰ期多为类圆形,两者存在统计学差异(P<0.0083)。Ⅰ期与Ⅱ、Ⅳ期的平均直径存在统计学差异(P<0.0083)。肿瘤钙化、囊变、坏死、密度、强化程度在TNM各分期间无统计学差异(P>0.0083)。瘤内血管穿行在Ⅳ期占比较Ⅰ期高,两者存在统计学差异(P<0.0083)。Ⅱ期均见心包/肺/膈神经侵犯,与Ⅰ期间存在统计学差异(P<0.0083)。Ⅲ期均见大血管/胸壁侵犯,与Ⅰ、Ⅱ期间存在统计学差异(P<0.0083)。Ⅳ期均见淋巴结/胸膜/肺/其他部位的转移,与其他三期存在统计学差异(P<0.0083)。结论TETs的TNM分期与临床、CT特征及组织病理分型存在一定相关性,可结合患者胸痛、重症肌无力、形态、平均直径、瘤内血管穿行、对邻近心包、肺、膈神经、大血管、胸壁的侵犯以及淋巴结、胸膜、肺等转移进行综合评估,提高术前分期及预后预测效能。
Objective To analyze the correlation between TNM staging(9th edition)of thymic epithelial tumors(TETs),clinical characteristics,CT features,and histopathological classification.Methods Collect the clinical and CT characteristics of 165 patients with TETs retrospectively who were diagnosed by surgical pathology.They were divided into early(stageⅠandⅡ)and advanced(stageⅢandⅣ)groups according to the 9th edition TNM staging of TETs.The WHO histopathological classification was simplified into low-risk group(type A,AB,and B1),high-risk group(type B2 and B3),and thymic carcinoma group.Analyze the correlation between TNM staging and clinical,CT characteristics as well as histopathological classification.Count data was tested byχ2 test,and measurement data was analyzed by variance analysis or K-W nonparametric test.Results In stageⅠ,most patients were asymptomatic(41.4%),while in stageⅣ,the most common symptoms were chest pain(37.5%)and cough(31.2%).Myasthenia gravis was more common in stagesⅡ(27.2%)andⅢ(23%)than in stageⅣ(4.2%).There was a moderate positive correlation between TNM staging and WHO simplified pathological classification,and the correlation was statistically significant.StageⅡ,Ⅲ,andⅣwere mostly irregular in shape and lobulated,mostly circular in shape in stageⅠ,which showed statistically significant differences(P<0.0083).There were statistically significant differences in mean diameter between stageⅠandⅡ,Ⅳ(P<0.0083).There were no significant differences in tumor calcification,cystic change,necrosis,density,enhancement degree,and vascular penetration within the tumor between the different stages of TNM(P>0.0083).In stageⅣ,there was a higher proportion of vascular penetration within the tumor compared to stageⅠ,which showed statistically significant differences(P<0.0083).StageⅡshowed pericardial/pulmonary/diaphragm nerve invasion,which differed significantly from stageⅠ(P<0.0083).StageⅢshowed large vessel/chest wall invasion,which differed significantly from stagesⅠandⅡ(P<0.0083).StageⅣshowed lymph node/pleural/lung/other metastasis,which differed significantly from all other stages(P<0.0083).Conclusion There is a certain correlation between the TNM staging of TETs and clinical characteristics,CT features,and histopathological classification.It can be comprehensively evaluated by combining patients'chest pain,myasthenia gravis,shape,mean diameter,vascular penetration within the tumor,invasion of adjacent pericardium,lungs,diaphragm nerves,large vessels,chest wall,and metastasis to lymph nodes,pleura,lungs,etc.,to improve preoperative staging and prognostic prediction efficiency.
作者
利玉林
罗振东
扈雪晗
成官迅
邓灵波
LI Yu-lin;LUO Zhen-dong;HU Xue-han;CHENG Guan-xun;DENG Ling-bo(Shantou University Medical College,Shantou 515041,Guangdong Province,China;Department of Radiology,Peking University Shenzhen Hospital,Shenzhen 518036,Guangdong Province,China;Department of Radiology,The University of Hong Kong-Shenzhen Hospital,Shenzhen 518053,Guangdong Province,China)
出处
《中国CT和MRI杂志》
2025年第8期67-70,共4页
Chinese Journal of CT and MRI
基金
深圳市科技计划资助(JCYJ20220531093817040)。
