CAJ | 학술논문

目的：研究临床Ⅰ期非小细胞肺癌患者发生纵膈淋巴结转移的独立危险因素，建立临床预测模型，以协助医生做出合理的诊疗策略。方法：回顾性分析739例术前胸部CT诊断为临床Ⅰ期，并通过手术治疗的非小细胞肺癌患者的临床资料，随机分为建模组和验证组。采用建模组病例资料，通过多因素分析筛选出N2淋巴结转移的独立危险因素，建立数学预测模型。采用验证组病例资料对该模型进行外部验证，并与已有的两组数学预测模型进行比较。结果：多因素分析结果显示，年龄、肿瘤大小、肿瘤位置以及病理类型是N2淋巴结转移的独立危险因素，数学预测模型为：N2淋巴结转移的可能性＝ex／（1＋ex），其中x＝－2．983＋（0．456×肿瘤直径）＋（1．753×位置）＋（1．787×病理类型）－（0．032×年龄）。Hosmer-Lemeshow拟合优度检验显示，预测值和观察值间差异无统计学意义（P＝0．923），受试者工作特征曲线的曲线下面积为0．748（95％CI：0．710～0．784）。外部验证结果显示，与VA模型相比，本研究模型的曲线下面积为0．781（95％CI：0．715～0．839），高于VA模型0．677（95％CI：0．604～0．744）（P＝0．04）。与Fudan模型相比，本研究模型的曲线下面积0．837（95％CI：0．760～0．897），高于Fudan模型0．766（95％CI：0．681～0．837）（P＜0．01）。结论：本研究对术前CT检查判断为临床Ⅰ期非小细胞肺癌的患者建立了N2淋巴结转移的数学预测模型，其准确性高于现有的其他模型，通过该模型可以对是否进行进一步的纵膈淋巴结的分期检查做出更合理的临床决策。
목적：연구림상Ⅰ기비소세포폐암환자발생종격림파결전이적독립위험인소，건립림상예측모형，이협조의생주출합리적진료책략。방법：회고성분석739례술전흉부CT진단위림상Ⅰ기，병통과수술치료적비소세포폐암환자적림상자료，수궤분위건모조화험증조。채용건모조병례자료，통과다인소분석사선출N2림파결전이적독립위험인소，건립수학예측모형。채용험증조병례자료대해모형진행외부험증，병여이유적량조수학예측모형진행비교。결과：다인소분석결과현시，년령、종류대소、종류위치이급병리류형시N2림파결전이적독립위험인소，수학예측모형위：N2림파결전이적가능성＝ex／（1＋ex），기중x＝－2．983＋（0．456×종류직경）＋（1．753×위치）＋（1．787×병리류형）－（0．032×년령）。Hosmer-Lemeshow의합우도검험현시，예측치화관찰치간차이무통계학의의（P＝0．923），수시자공작특정곡선적곡선하면적위0．748（95％CI：0．710～0．784）。외부험증결과현시，여VA모형상비，본연구모형적곡선하면적위0．781（95％CI：0．715～0．839），고우VA모형0．677（95％CI：0．604～0．744）（P＝0．04）。여Fudan모형상비，본연구모형적곡선하면적0．837（95％CI：0．760～0．897），고우Fudan모형0．766（95％CI：0．681～0．837）（P＜0．01）。결론：본연구대술전CT검사판단위림상Ⅰ기비소세포폐암적환자건립료N2림파결전이적수학예측모형，기준학성고우현유적기타모형，통과해모형가이대시부진행진일보적종격림파결적분기검사주출경합리적림상결책。
Objective:To estimate the probability of N2 lymph node metastasis and to assist physicians in making diagnosis and treatment decisions.Methods:We reviewed the medical records of 739 patients with computed tomography-defined stage Ⅰ non-small cell lung cancer ( NSCLC ) that had an exact tumor-node-metastasis stage after surgery.A random subset of three fourths of the patients ( n =554 ) were selected to develop the prediction model.Logistic regression analysis of the clinical characteristics was used to estimate the independent predictors of N2 lymph node metastasis.A prediction model was then built and externally validated by the remaining one fourth ( n=185 ) patients which made up the validation data set.The model was also compared with 2 previously described models.Results:We iden-tified 4 independent predictors of N2 disease:a younger age, larger tumor size, central tumor location, and adenocarcinoma or adenosquamous carcinoma pathology.The model showed good calibration ( Hos-mer-Lemeshow test:P=0.923) with an area under the receiver operating characteristic curve (AUC) of 0.748 (95%confidence interval, 0.710-0.784) .When validated with all the patients of group B, the AUC of our model was 0.781 (95% CI: 0.715 -0.839) and the VA model was 0.677 (95% CI:0.604-0.744) (P =0.04).When validated with T1 patients of group B, the AUC of our model was 0.837 (95%CI:0.760 -0.897) and Fudan model was 0.766 (95% CI: 0.681 -0.837) (P <0.01) .Conclusion:Our prediction model estimated the pretest probability of N2 disease in computed tomography-defined stageⅠNSCLC and was more accurate than the existing models.Use of our model can be of assistance when making clinical decisions about invasive or expensive mediastinal staging procedures.