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肺腺癌淋巴结转移危险因素的回顾性研究
作者:陆运  薛涛  胡若愚  马腾  吴坤鹏  马艺洪  王雷 
单位:东南大学附属中大医院 心胸外科, 江苏 南京 210009
关键词:肺腺癌 淋巴结转移 影响因素 
分类号:R734.2;R73-37
出版年·卷·期(页码):2019·38·第三期(505-510)
摘要:

目的:探讨影响原发性肺腺癌淋巴结转移的影响因素用以预测患者淋巴结转移情况,以期对术中淋巴结清扫范围的选择及指导术后治疗提供帮助。方法:回顾性分析229例原发性肺腺癌患者的临床资料,患者经肺叶切除术或亚肺叶切除(肺段及楔形切除),且均行系统淋巴结清扫或采样。对其淋巴结转移情况以及影响淋巴结转移相关因素进行单因素和Logistic多因素分析。结果:229例患者中发生淋巴结转移52例(22.7%),单因素分析显示,肿瘤直径、病理亚型、术前癌胚抗原(CEA)水平、细胞核增值抗原(Ki67)表达量、CT值等为影响淋巴结转移的因素(P<0.05);Logistics多因素分析显示患者的肿瘤直径(OR=1.859,95%CI=1.328~2.601,P=0.001)、术前CEA水平(OR=1.009,95%CI=1.038~1.164,P=0.001)是患者淋巴结发生转移的独立危险因素。结论:肺腺癌患者的术前CEA水平、肿瘤直径是淋巴结转移的独立危险因素,对淋巴结转移有很好的预测作用。

Objective:To explore the influencing factors of lymph node metastasis of primary lung adenocarcinoma so as to provide guidance for selecting the range of lymph node dissection and postoperative treatment. Methods:Retrospective analysis of clinical data of 229 patients with primary lung adenocarcinoma was conducted. Transpulmonary lobectomy or sublobectomy was performed on the patients, and lymph node dissection or extraction was conducted. Related factors of lymph node metastasis were analyzed by single factor and Logistics multivariate analysis. Results:Fifty-two cases of lymph node metastases(22%) were found in all the 229 patients. The single factor analysis showed that the tumor diameter, pathological subtype, level of CEA, expression of Ki67 and the value of CT were the influencing factors of lymph node metastasis(P<0.05). The Logistics multifactor analysis showed that the tumor diameter(OR=1.859,95%CI=1.328-2.601,P=0.001) and the level of preoperative CEA(OR=1.009,95%CI=1.038-1.164,P=0.001)were the independent risk factors for the metastasis of the lymph nodes. Conclusion:The preoperative CEA level and tumor diameter in patients with lung adenocarcinoma are independent risk factors for lymph node metastasis, which are the key factors for predicting the lymph node metastasis.

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