本文選題：非小細(xì)胞肺癌 + 危險因素　； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：目的：準(zhǔn)確的分期對于非小細(xì)胞肺癌的治療極其重要,本研究旨在研究分析臨床IA期非小細(xì)胞肺癌患者術(shù)后病理證實(shí)出現(xiàn)縱隔淋巴結(jié)轉(zhuǎn)移的發(fā)生率,確定易發(fā)生縱隔淋巴結(jié)轉(zhuǎn)移的臨床IA期非小細(xì)胞肺癌的危險人群,指導(dǎo)臨床選擇合適手術(shù)適應(yīng)癥的患者。同時確定淋巴結(jié)轉(zhuǎn)移站點(diǎn)與腫瘤所在位置的關(guān)系,為優(yōu)化淋巴結(jié)清掃提供理論數(shù)據(jù)支持。 方法：本研究回顧性分析2011年1月—2013年1月期間于我科行外科治療的臨床IA期患者資料,統(tǒng)計(jì)術(shù)后病理確診為縱隔淋巴結(jié)轉(zhuǎn)移比例,通過單因素和多因素分析確定縱隔淋巴結(jié)轉(zhuǎn)移危險因素,同時使用受試者工作特征曲線(ROC)及約登指數(shù)指數(shù)確定危險因素的最佳分界值。同時分析淋巴結(jié)轉(zhuǎn)移性肺癌的轉(zhuǎn)移站點(diǎn)與腫瘤所在肺葉的相關(guān)性。 結(jié)果：本研究納入552例臨床IA期患者,105例(19.0%)患者術(shù)后病理證實(shí)為縱隔淋巴結(jié)轉(zhuǎn)移。多因素分析提示3個獨(dú)立危險因素,分別為性別(OR=2.722,p=0.001),術(shù)前血清CEA水平(OR=1.049,p=0.006),腫瘤大小(OR：1.875,p=0.002)。ROC曲線及約登指數(shù)提示腫瘤大小及血清CEA值的最佳分界值分別為1.8cm,5.2ng/ml。分析105例縱隔淋巴結(jié)轉(zhuǎn)移性腫瘤顯示,右上葉腫瘤轉(zhuǎn)移至第4組淋巴結(jié)的比例顯著高于右下葉腫瘤(p0.001),兩者分別為76.7%,32.0%,而右上葉腫瘤轉(zhuǎn)移至第7組淋巴結(jié)的比例顯著低于右下葉腫瘤(p=0.002),兩者比例分別為23.3%,64.0%。左上葉腫瘤發(fā)生5,6組淋巴結(jié)轉(zhuǎn)移的比例明顯高于左下葉腫瘤(p=0.003),分別為90.9%,62.5%,而左下葉轉(zhuǎn)移至第7組淋巴結(jié)比例明顯高于左上葉,分別為0%,56.3%,兩者差異有顯著性(p0.001)。 結(jié)論：臨床IA期肺癌患者發(fā)生縱隔淋巴結(jié)轉(zhuǎn)移的比例較高,因此對于此類患者仍因行系統(tǒng)性地淋巴結(jié)清掃或采樣以獲得術(shù)后準(zhǔn)確的病理分期。對有相關(guān)危險因素的患者,術(shù)前需進(jìn)行更準(zhǔn)確的臨床分期以避免不恰當(dāng)?shù)闹委煼绞健７伟┝馨徒Y(jié)轉(zhuǎn)移站點(diǎn)存在肺葉特異性。 目的：準(zhǔn)確的臨床分期對于非小細(xì)胞肺癌患者的正確診治極其重要,尤其是對于臨床T1aNOMO患者,因其可以作為肺段切除的參考適應(yīng)癥,本研究旨在探討臨床T1aNOMO患者術(shù)后病理證實(shí)出現(xiàn)淋巴結(jié)轉(zhuǎn)移比例及其相關(guān)危險因素,指導(dǎo)選擇肺段切除的最佳適應(yīng)癥患者。 方法：本研究回顧性分析2011年1月—2013年6月期間于我科行外科治療的臨床T1aNOMO患者資料,統(tǒng)計(jì)術(shù)后病理確診為淋巴結(jié)轉(zhuǎn)移的比例,通過單因素和多因素分析確定該臨床分期患者發(fā)生淋巴結(jié)轉(zhuǎn)移危險因素。 結(jié)果：該研究共納入315例患者,發(fā)生淋巴結(jié)轉(zhuǎn)移51例(16.2%),其中N1淋巴結(jié)發(fā)生轉(zhuǎn)移的共39例(12.4%),N2發(fā)生轉(zhuǎn)移的共41例(13.0%),29例患者(9.2%)N1、N2淋巴結(jié)同時存在轉(zhuǎn)移,12例(3.8%)患者存在跳躍性N2轉(zhuǎn)移。術(shù)前影像學(xué)結(jié)節(jié)大小,非上葉腫瘤,血清癌胚抗原(CEA)升高,微乳頭狀腺癌為淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險因素。 結(jié)論：臨床T1aNOMO患者發(fā)生淋巴結(jié)轉(zhuǎn)移的比例較高,選擇行肺段切除之前需準(zhǔn)確評估該分期的患者,尤其是對于有上述危險因素的患者。
[Abstract]:Objective: accurate staging is very important for the treatment of non small cell lung cancer. The purpose of this study is to analyze the incidence of mediastinal lymph node metastases in patients with stage IA non-small cell lung cancer (non-small cell lung cancer) and to determine the risk population of IA non small cell lung cancer (non small cell lung cancer) with mediastinal lymph node metastasis, and to guide the clinical selection. At the same time, the location of lymph node metastasis and the location of tumor were also determined to provide theoretical data support for optimizing lymph node dissection.
Methods: a retrospective analysis of the clinical data of IA patients in our department from January 2011 to January 2013 was reviewed. The proportion of mediastinal lymph node metastases was confirmed by pathology after surgery. The risk factors of mediastinal lymph node metastases were determined by single factor and multifactor analysis, and the subjects' work feature curve (ROC) and Joseph's finger were also used. The number index was used to determine the best cut-off value of risk factors. Meanwhile, the correlation between metastatic sites of lymph node metastatic lung cancer and lung lobe of tumor was analyzed.
Results: This study included 552 patients with clinical IA stage, 105 (19%) patients proved to be mediastinal lymph node metastasis after operation. Multivariate analysis suggested that 3 independent risk factors were sex (OR=2.722, p=0.001), preoperative serum CEA level (OR=1.049, p=0.006), OR:1.875, p=0.002.ROC curve and Joseph's index. The best demarcation value of the size and CEA value of the serum was 1.8cm. 5.2ng/ml. analysis of 105 cases of metastatic tumor of the mediastinal lymph nodes showed that the proportion of the right upper lobe tumor to fourth groups was significantly higher than that of the right lower lobe tumor (p0.001), which were 76.7% and 32% respectively, while the proportion of the right upper lobe metastases to the seventh lymph nodes was significantly lower than that of the lower right lobes. The proportion of tumor (p=0.002) was 23.3%. The proportion of lymph node metastasis in 5,6 group of 64.0%. left upper lobe tumor was significantly higher than that of left lower lobe tumor (p=0.003), which was 90.9% and 62.5% respectively. The ratio of left lower lobe to seventh groups was significantly higher than that in upper left lobe, 0% and 56.3%, respectively (p0.001).
Conclusion: the incidence of mediastinal lymph node metastasis in patients with stage IA lung cancer is higher, so the patient still has a systematic lymphnode dissection or sampling to obtain accurate postoperative pathological staging. For patients with related risk factors, a more accurate clinical period is required before surgery to avoid inappropriate treatment. Pulmonary lobe specificity exists in the nodal metastasis site.
Objective: accurate clinical staging is very important for the correct diagnosis and treatment of patients with non-small cell lung cancer, especially for clinical T1aNOMO patients, because it can be used as a reference indication for pulmonary segmental resection. The purpose of this study is to explore the incidence of lymph node transfer and related risk factors in clinical T1aNOMO patients, and to guide the selection of lung. The best adaptable patient with segmental resection.
Methods: a retrospective analysis of the clinical data of T1aNOMO patients in our department from January 2011 to June 2013 was reviewed. The proportion of lymph node metastases was confirmed by pathology after surgery, and the risk factors of lymph node metastasis were determined by single factor and multi factor analysis.
Results: the study included 315 patients with 51 cases of lymph node metastasis (16.2%), of which 39 cases of N1 lymph node metastasis (12.4%), 41 cases (13%), 29 patients (9.2%) N1, N2 lymph node metastasis and 12 (3.8%) patients with jump N2 metastasis. Embryonal antigen (CEA) is elevated and micro papillary adenocarcinoma is an independent risk factor for lymph node metastasis.
Conclusion: the proportion of lymph node metastases in the clinical T1aNOMO patients is higher. The patients who are selected for the stage of the pulmonary resection should be accurately evaluated, especially for the patients with the risk factors mentioned above.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R734.2

【共引文獻(xiàn)】

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本文編號：1960706