摘要目的 分析T1a期肺腺癌患者的临床资料,确定与淋巴结转移相关的临床因素.方法 回顾性分析2012年1-6月217例表现为外周型小结节直径＜2 cm的T1a肺腺癌患者资料,其中男性105例,女性112例；年龄32 ～ 85岁,平均(61±11)岁.记录淋巴结转移相关的临床因素,包括年龄、性别、吸烟史、症状、肿瘤大小、影像学表现、胸膜受侵、空气支气管征、癌胚抗原、手术方式、病理分型及淋巴结转移情况,部分患者曾行PET-CT者则记录最大标准摄取值(SUVmax).通过单因素及多因素分析,寻找容易发生淋巴结转移的临床相关因素.结果 表现为纯磨玻璃影的35例患者中,有11例为不典型腺瘤样增生,有24例为原位腺癌,无一例发生淋巴结转移；表现为混合型磨玻璃影的89例患者中84例(94.4％)无淋巴结转移,只有5例(6.0％)患者发生淋巴结转移；而表现为实性结节的93例患者中共有28例(30.1％)发生淋巴结转移；三者间淋巴结转移差异具有统计学意义(x2=23.41,P＜0.001).单因素分析发现,肿瘤直径＞1 cm(x2 =9.021,P＜0.003)、影像学表现为混合性结节或实性结节(x2 =23.41,P＜0.000)、癌胚抗原＞5 μg/L(x2 =15.541,P＜0.000)及SUVmax＞5(x2=0.644,P＜0.000)是影响肺腺癌淋巴结转移的相关因素.多因素分析显示影像学表现为混合性结节或实性结节是淋巴结转移的独立相关临床因素(OR=166.116,95％ CI:18.161～25.19,P＜0.001).结论 高分辨CT表现为纯毛玻璃影的患者一般没有淋巴结转移,肿瘤直径＞1 cm、影像学表现为混合性结节或实性结节、癌胚抗原＞5 μg/L、SUVmax＞5的肺腺癌患者更易发生淋巴结转移；其中影像学表现为混合性结节或实性结节是淋巴结转移的独立相关临床因素.

abstractsObjective To analyze the data of patients with clinical stage T1a lung adenocarcinoma and find the predictive factors associated with lymph node metastasis.Methods From January to June 2012,271 patients with small nodules of peripheral lung adenocarcinoma were enrolled in the retrospective review.There were 105 male and 112 female patients,with an average age of (61 ± 11) years (range 32-85 years).The data were collected including age,gender,smoking history,carcinoembryonic antigen (CEA),imaging findings,surgical procedure,pleural involvement,symptoms,tumor size,pathological classification,pathologic stage,maximum standardized uptake value(SUVmax) and lymph node metastasis.The predictive factors of lymph node metastasis in clinical factors were detected by univariate and multivariate analysis.Results By preoperative thin-section CT,35 patients were categorized as pure ground-grass opacity(GGO),11 cases of atypical adenomatous hyperplasia,24 cases of adenocarcinoma in situ,with no lymph node metastasis.Categorized as mixed ground-glass opacities in 89 patients,84 patients (94.4％) had no lymph node metastasis,only 5 patients (6.0％) with lymph node metastasis.Categorized as solid nodules in 93 patients,a total of 28 cases (30.1％) had lymph node metastasis.There were statistically significant difference between three groups(x2 =23.41,P ＜ 0.001).By univariate analysis,we found that the predictive factors of lymph node metastasis were as follows:tumor size ＞ 1 cm(x2 =9.021,P ＜0.003),imaging performance with mixed GGO or solid nodules (x2 =23.41,P ＜ 0.000),CEA ＞5 μg/L (x2 =15.541,P ＜ 0.000) and PET-CT SUVmax ＞ 5 (x2 =0.644,P ＜ 0.000).By multivariate analysis,we found that imaging performance(mixed GGO or solid nodules) was the independent predictor of lymph node metastasis in clinical factors (OR =166.116,95 ％ CI:18.161-25.19,P ＜ 0.001).Conclusions Patients of pure GGO generally do not have lymph node metastasis.Tumor diameter ＞ 1 cm,imaging findings with the mixed GGO or solid nodules,carcinoembryonic antigen CEA ＞ 5 μg/L,PET-CT SUVmax ＞ 5 are predictive factors of lymph node metastasis in which imaging is independent predictor.