發(fā)布時(shí)間：2018-05-14 21:29

  本文選題：Ⅰ期肺腺癌 + 亞實(shí)性肺結(jié)節(jié)�。� 參考：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討亞實(shí)性結(jié)節(jié)型Ⅰ期肺腺癌的影像學(xué)特點(diǎn),分析其與良性亞實(shí)性結(jié)節(jié)的差異,為良惡性結(jié)節(jié)的鑒別診斷提供參考�；仡櫺苑治鲇跋癖憩F(xiàn)為亞實(shí)性肺結(jié)節(jié)Ⅰ期肺腺癌患者的臨床特點(diǎn)和預(yù)后因素,研究腫瘤中實(shí)性成分的比例(C/T比值,consolidation to tumor ratio)與患者預(yù)后的關(guān)系。方法:收集來(lái)自大連醫(yī)科大學(xué)第一附屬醫(yī)院胸外科2008年1月至2010年12月收治的90例后經(jīng)手術(shù)、病理證實(shí)為Ⅰ期周圍型肺腺癌且CT影像下均表現(xiàn)為亞實(shí)性肺結(jié)節(jié)的患者病例資料。采用的隨訪策略為,術(shù)后第一年每3個(gè)月做1次隨訪,術(shù)后第2年每半年做1次隨訪,術(shù)后第3年至隨訪截止每年做1次隨訪,隨訪截止日期為2014年12月。獲取患者生存情況和相關(guān)臨床信息如體格檢查、血液生化、腫瘤標(biāo)記物、胸腹部CT、全身骨掃描檢查或者PET-CT檢查等結(jié)果。另收集76例我院從2012年1月至2014年12月收治的影像學(xué)表現(xiàn)為混合性磨玻璃樣結(jié)節(jié)(m GGN),后經(jīng)手術(shù)病理學(xué)證實(shí)為良性肺結(jié)節(jié)的患者作為對(duì)照,獲取患者影像學(xué)信息。采用卡方檢驗(yàn)對(duì)C/T比值、毛刺征、分葉征、胸膜牽拉征、支氣管充氣征和血管集束征六組數(shù)據(jù)在良惡性結(jié)節(jié)的鑒別上是否存在差異進(jìn)行統(tǒng)計(jì)分析。將從90例肺腺癌患者獲得的臨床和病理資料進(jìn)行回顧性分析,根據(jù)生存情況評(píng)估Ⅰ期肺腺癌患者的性別、年齡、手術(shù)方式、病理分化程度、腫瘤實(shí)性成分占腫瘤最大徑的比值(C/T比值)以及各影像學(xué)特點(diǎn)等相關(guān)臨床因素對(duì)長(zhǎng)期生存的影響。所有數(shù)據(jù)均采用SPSS20.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,當(dāng)P值0.05時(shí)被認(rèn)為具有統(tǒng)計(jì)學(xué)意義。繪制受試者工作(ROC)曲線,確定最佳截?cái)帱c(diǎn)(Optimal cut-off point)。Kaplan-Merier法行單因素分析,并繪制生存曲線,Log-rank檢驗(yàn)比較組間差異。結(jié)果:90例肺腺癌患者中,男性34例(37.8%),女性56例(62.2%);年齡范圍53歲-82歲,中位年齡62歲;行肺葉切除術(shù)患者72例(80.0%),肺局部切除術(shù)患者13例(14.4%),其他切除患者5例(5.0%);病理報(bào)告呈高分化病例65例(72.2%),中分化14例(15.6%),低分化11例(12.2%);影像學(xué)表現(xiàn)為分葉征67例(74.4%),毛刺征70例(77.8%),胸膜牽拉征21例(23.3%),支氣管充氣征26例(28.9%),血管集束征16例(17.8%)。受試者工作特征(ROC)曲線顯示對(duì)于肺腺癌惡性結(jié)節(jié)和良性結(jié)節(jié)針對(duì)C/T比值的區(qū)分,其最大曲線下面積(AUC,area under the curve)為0.73,95%置信區(qū)間(CI,Confidence interval)為0.69-0.80,表明此實(shí)驗(yàn)具有一定準(zhǔn)確性,最佳截?cái)帱c(diǎn)(Optimal cut-off point)約為0.50。良性組和惡性組在C/T比值、分葉征、毛刺征、支氣管充氣征(P0.05)等方面差異顯著,具有統(tǒng)計(jì)學(xué)意義。Kaplan-Merier單因素生存分析顯示,C/T比值是影響Ⅰ期肺腺癌預(yù)后的因素。其中C/T比值0.50的患者五年生存率明顯比0.50的患者的生存率低,分別為40.1%和84.3%,P0.05。結(jié)論:C/T比值大小、分葉征、毛刺征、支氣管充氣征是亞實(shí)性型良性肺結(jié)節(jié)和肺腺癌結(jié)節(jié)的鑒別要點(diǎn)。C/T比值是影像表現(xiàn)為亞實(shí)性肺結(jié)節(jié)的Ⅰ期肺腺癌患者預(yù)后危險(xiǎn)因素之一。
[Abstract]:Objective: To investigate the imaging features of phase I lung adenocarcinoma of subsolid nodular type, analyze the difference between the benign nodule and benign nodule, and provide reference for the differential diagnosis of benign and malignant nodules. The clinical and prognostic factors of the patients with stage I lung adenocarcinoma of subsolid pulmonary nodules were analyzed retrospectively, and the ratio of the solid components in the tumor (C/T ratio) was studied. Value, the relationship between consolidation to tumor ratio) and the prognosis of patients. Methods: 90 cases from the Department of thoracic surgery, the First Affiliated Hospital of Dalian Medical University, from January 2008 to December 2010, were collected and treated by surgery. The case data of patients with stage I peripheral pulmonary adenocarcinoma confirmed by pathology with CT image as subsolid pulmonary nodules were collected. The follow-up policy was adopted. For the first year after the operation, 1 follow-up was done every 3 months, 1 follow-up second years after second years, third years after third to 1 follow-up, and the follow-up deadline was December 2014. The patient's survival and related clinical information such as physical examination, blood biochemistry, tumor markers, thoracic and abdominal CT, whole body bone scan examination, or PET-CT The imaging findings of 76 cases in our hospital from January 2012 to December 2014 were collected as mixed grind glass like nodules (m GGN). The imaging information of patients with benign pulmonary nodules confirmed by surgery and pathology was taken as control. The ratio of C/T, burr sign, lobulated sign, pleural stretch sign, bronchus and bronchi were used. Six groups of data on the differentiation of benign and malignant nodules were statistically analyzed. The clinical and pathological data obtained from 90 cases of lung adenocarcinoma were retrospectively analyzed. The sex, age, hand mode, pathological differentiation, and solid composition of the patients with stage I lung adenocarcinoma were evaluated according to the survival conditions. The effect of the ratio of the maximum diameter of the tumor (C/T ratio) and the various imaging characteristics on the long-term survival. All data were statistically analyzed by SPSS20.0 software. When the value of P was 0.05, the statistical significance was considered. The ROC curve was drawn and the best truncation point (Optimal cut-off point).Kaplan-Meri was determined. A single factor analysis was performed by Er, and the survival curve was plotted. Results: among the 90 cases of lung adenocarcinoma, 34 (37.8%) and 56 women (62.2%) were male, 53 years old and 62 years old, 72 (80%), 13 (14.4%) patients with lobectomy, 5 (5%) in other excised patients, and pathology, and pathology. The report showed 65 cases of highly differentiated cases (72.2%), 14 cases of middle differentiation (15.6%), 11 cases of low differentiation (12.2%), 67 cases of lobulation syndrome (74.4%), 70 cases of burr sign (77.8%), 21 cases of pleural stretch sign (23.3%), bronchoalveolar sign 26 cases (28.9%), and vascular bundle sign (ROC) curve showed malignant nodules of lung adenocarcinoma and the malignant nodules of lung adenocarcinoma. The benign nodule was distinguished from the C/T ratio, and the area under the maximum curve (AUC, area under the curve) was 0.73,95% confidence interval (CI, Confidence interval) as 0.69-0.80, indicating that the experiment was accurate and the best truncation point was about the ratio of benign and malignant groups, lobulation sign, burr sign, bronchial filling. There were significant differences in gas sign (P0.05). The statistical significance of.Kaplan-Merier single factor survival analysis showed that the C/T ratio was a prognostic factor for stage I lung adenocarcinoma. The five year survival rate of patients with C/T ratio 0.50 was significantly lower than that of 0.50 patients, 40.1% and 84.3% respectively, P0.05. conclusion: the C/T ratio, lobular sign, Mao Cizheng The identification of bronchoalveolar sign is a subsolid benign pulmonary nodule and a lung adenocarcinoma nodule. The.C/T ratio is one of the risk factors for the prognosis of patients with stage I lung adenocarcinoma with subsolid pulmonary nodules.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R734.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊晉平,王澤,張?zhí)K;肺腺癌5-羥色胺受體的免疫組織化學(xué)定位[J];四川解剖學(xué)雜志;2003年02期

2 吳一龍,林嘉穎,楊學(xué)寧,喬貴賓,王坤,陳剛;肺腺癌患者酪氨酸激酶信號(hào)傳導(dǎo)通路的異常與臨床預(yù)后[J];中華醫(yī)學(xué)雜志;2004年12期

3 張利群,陳杭薇,王四海,辛慶紅,杜玉國(guó),尤蘭華;人呼吸道合胞病毒轉(zhuǎn)錄調(diào)節(jié)基因轉(zhuǎn)染肺腺癌細(xì)胞系的研究[J];山東醫(yī)藥;2005年12期

4 黎聯(lián);梅同華;周向東;張新高;車德亞;;細(xì)胞外信號(hào)調(diào)節(jié)激酶信號(hào)通路與基質(zhì)金屬蛋白酶-26在肺腺癌表達(dá)中的關(guān)系[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2009年02期

5 王亞南;顧國(guó)浩;;生物芯片在肺腺癌研究和診療中的應(yīng)用進(jìn)展[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2011年02期

6 ;我國(guó)人體肺腺癌細(xì)胞系建立[J];腫瘤;1981年06期

7 季晨陽(yáng),張義R，

本文編號(hào)：1889503