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非小细胞肺癌N2淋巴结转移的危险因素分析

Risk factors for N2 lymphatic metastasis in patients with non-small cell lung cancer

摘要:

目的 研究多种影响因素与NSCLC N2淋巴结转移之间的关系.方法 回顾性分析接受18F-FDG PET/CT检查和手术治疗的NSCLC患者,将其分为无N2淋巴结转移(非N2+)和有N2淋巴结转移(N2+)2组,采用x2检验或两样本t检验比较2组间性别、年龄、肿瘤部位、肿瘤大小、SUVmax、病理学类型及分化程度等影响因素的差异,然后将组间有统计学意义的影响因素及分组进行量化赋值,先后用单因素回归和多因素logistic回归分析确定对N2淋巴结转移有意义的危险因素.结果 共纳入177例患者,其中男109例,女68例,年龄(60.1±10.6)岁.非N2+(142例)和N2+(35例)2组间的肿瘤大小[(36.1±19.7) mm和(49.3±24.4) mm]、SUVmax(8.81±6.23和11.21±4.43)和分化程度(高分化:3和0例;中分化:74和11例;低分化:65和24例)差异均有统计学意义(t=-2.969和-2.633,x2=6.143,均P<0.05),而性别、年龄、肿瘤部位和组织学类型差异均无统计学意义(x2=0.374~4.999,t=0.836,均P>0.05).单因素分析显示,肿瘤大小、SUVmax及分化程度与N2淋巴结转移相关(r=0.201、0.245和0.185,均P<0.05);而多因素分析示,只有SUVmax与N2淋巴结转移之间的相关性具有统计学意义(β=0.546,P<0.01).NSCLC N2淋巴结的转移概率随着原发病灶SUVmax的增加而增加;当原发灶SUVmax≤2.5时,发生N2淋巴结转移的概率为0,而SUVmax>7.5时概率为0.29.结论 SUVmax是NSCLC发生N2淋巴结转移的危险因素.

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Objective To assess risk factors in NSCLC with N2 metastasis.Methods A total of 177 NSCLC patients (109 males,68 females; age:(60.1 ± 10.6) years) who underwent both 18F-FDG PET/CT scan and surgery were enrolled.They were divided into two groups.One was with N2 metastasis (N2+) and the other was without (non-N2+).The gender,age,location,size,primary tumor SUVmax,histopathologic type and differentiation grade between N2+ group and non-N2+ group were compared with x2 test and two-sample t test.After assignment of significant factors and groups,correlations between each factor and group were analyzed with uni-and multivariate analyses,and then the risk factors were identified finally with logistic regression analysis.Results Significant difference among factors of tumor size ((36.1±19.7) mm vs (49.3±24.4) mm),SUVmax(8.81±6.23 vs 11.21±4.43) and differentiation grades (high:3 vs 0; moderate:74 vs 11; poor:65 vs 24) were observed between non-N2+ group and N2+ group (t =-2.969,-2.633,x2 =6.143,all P<0.05).Besides,the univariate analysis showed significant correlations between tumor size,SUVmax,differentiation grade and N2 status (r=0.201,0.245,0.185,all P<0.05).However,multivariate logistic regression revealed that only SUVmax had a predictive value (β=0.546,P<0.01).The incidence of N2 metastasis went up along with the increase of SUVmax.There was no N2 metastasis in the patients with SUVmax ≤2.5,and the incidence rate of metastasis increased to 0.29 in those with SUVmax>7.5.Conclusion SUVmax may be an independent risk factor to predict N2 metastasis in NSCLC patients.

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