最大径≤30 mm胸膜附着型非小细胞肺癌脏层胸膜侵犯的多因素分析

Multivariate analysis of visceral pleural invasion in pleural-adherent non-small cell lung cancer with maximum diameter ≤30 mm

    摘要
  • 摘要:
    目的 探索最大径≤30 mm胸膜附着型非小细胞肺癌（NSCLC）发生脏层胸膜侵犯（VPI）的危险因素。
    方法 采用横断面设计，回顾性分析江苏大学附属昆山医院2023年1月至2024年9月经术后组织病理学检查确诊的115例胸膜附着型NSCLC患者的临床资料、影像资料、组织病理学检查资料，其中男性48例、女性67例，年龄63（54, 69）岁。所有患者均以弹性纤维染色结果为“金标准”被分为VPI阳性组与VPI阴性组。2组间比较采用χ2检验（若频数<1则采用Fisher确切概率法检验）或Mann-Whitney U检验。采用二元Logistic回归分析筛选预测胸膜附着型NSCLC发生VPI的独立危险因素并构建预测模型。采用受试者工作特征曲线评估各独立危险因素及预测模型的预测效能。
    结果 115例胸膜附着型NSCLC患者中，VPI阴性组68例、VPI阳性组47例。单因素分析结果显示，2组患者间性别（χ2=6.028，P=0.014）、年龄（Z=−2.636，P=0.008）、病理类型（Fisher确切概率法，P=0.001）、细胞增殖核抗原Ki-67表达（Z=−4.583，P<0.001）、密度类型（χ2=15.517，P<0.001）、支气管改变（χ2=5.452，P=0.020）、胸膜凹陷或增厚（χ2=7.315，P=0.007）、病灶最大径（Z=−3.169，P=0.002）、实性成分最大径（Z=−4.533，P<0.001）、肿瘤实性成分占比（Z=−3.577，P<0.001）、病灶与胸膜接触长度（Z=−4.797，P<0.001）、实性部分接触长度（Z=−5.665，P<0.001）、病灶接触胸膜特征（χ2=32.053，P<0.001）、邻近层面特征（χ2=45.698，P<0.001）的差异均有统计学意义。多因素Logistic回归分析显示，实性部分接触长度（OR=1.087，95%CI：1.003~1.177）、胸膜凹陷或增厚（OR=7.628，95%CI：1.561~37.279）、病灶接触胸膜特征（Ⅲ型）（OR=7.060，95%CI：2.048~24.340）、邻近层面特征（Ⅳ型）（OR=10.653，95%CI：3.388~33.500）是预测胸膜附着型NSCLC发生VPI的独立危险因素（均P<0.05）。基于四者的联合预测模型具有良好的预测效能曲线下面积=0.919（95%CI：0.869~0.968），灵敏度为83.0%，特异度为88.2%。
    结论 对于胸膜附着型NSCLC，当术前CT提示病灶与胸膜呈钝角型附着、邻近层面有多条（≥3）胸膜标签、有胸膜凹陷或增厚且实性部分接触长度>12.5 mm时，则高度提示存在VPI的可能。

     

    Abstract:
    Objective To explore the risk factors for the development of visceral pleural invasion (VPI) in pleural-adherent non-small cell lung cancer (NSCLC) with maximum diameter ≤30 mm.
    Methods A cross-sectional study design was employed and a retrospective analysis was conducted on the clinical, imaging and histopathological examination data of 115 patients with pleural-adherent NSCLC diagnosed by post-operative histopathological examination from January 2023 to September 2024 in Kunshan Hospital, Jiangsu University. The patients included 48 males and 67 females, aged 63(54, 69) years. Using the elastic fiber staining results as the "gold standard", the 115 pleural-adherent NSCLC patients were divided into VPI-positive and VPI-negative groups. Chi-square test (or Fisher exact probability method if the expected frequency is <1) or Mann-Whitney U test was used for comparisons between two groups. Binary Logistic regression was employed to identify independent risk factors for VPI in pleural-adherent NSCLC and construct a predictive model. The predictive performance of each independent risk factor and the model was evaluated using receiver operating characteristic curves.
    Results Among the 115 patients with pleural-adherent NSCLC, 68 cases were allocated to the VPI-negative group and 47 cases were allocated to the VPI-positive group. Univariate analysis showed statistically significant differences in gender (χ2=6.028, P=0.014), age (Z=−2.636, P=0.008), pathological type (Fisher exact probability method, P=0.001), cell proliferating nuclear antigen Ki-67 (Z=−4.583, P<0.001), density type (χ2=15.517, P<0.001), bronchial changes (χ2=5.452, P=0.020), pleural indentation or thickening (χ2=7.315, P=0.007), maximum lesion diameter (Z=−3.169, P=0.002), maximum diameter of consolidation (Z=−4.533, P<0.001), consolidation-to-tumor ratio (Z=−3.577, P<0.001), lesion-pleural contact length (Z=−4.797, P<0.001), consolidation-pleural contact length (Z=−5.665, P<0.001), lesion-pleural contact feature (χ2=32.053, P<0.001) and adjacent slice feature (χ2=45.698, P<0.001). Multivariate Logistic regression analysis demonstrated that consolidation-pleural contact length (OR=1.087, 95%CI: 1.003–1.177), pleural indentation or thickening (OR=7.628, 95%CI: 1.561–37.279), lesion-pleural contact feature (type Ⅲ) (OR=7.060, 95%CI: 2.048–24.340) and adjacent slice features (type Ⅳ) (OR=10.653, 95%CI: 3.388–33.500) were independent risk factors for VPI in patients with pleural-adherent NSCLC (all P<0.05). The combined predictive model established on the basis of these four factors had favorable predictive performance, with an area under the curve of 0.919 (95%CI: 0.869–0.968), a sensitivity of 83.0% and a specificity of 88.2%.
    Conclusions For patients with pleural-adherent NSCLC, the possibility of VPI is highly suggestive when preoperative CT showing that the lesion is adherent to the pleura in an obtuse angle, the presence of multiple (≥3) pleural tags on adjacent slices, pleural indentation or thickening, with the consolidation-pleural contact length being greater than 12.5 mm.

     

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