Page 27 - 南京医科大学自然版

第45卷第4期 南京医科大学学报（自然科学版）
2025年4月 Journal of Nanjing Medical University（Natural Sciences） ·463 ·

·专题研究：肿瘤·

基于CT上肿瘤⁃胸膜位置关系预测肺腺癌患者隐匿性纵隔淋巴

结转移的临床价值

郝沁敏 ，贾亦真 ，李 海 ，俞同福 ，徐 海 ，袁 梅 1*
2
1
1
1
1
南京医科大学第一附属医院放射科，病理科，江苏 南京 210029
1 2
［摘 要］ 目的：基于肺腺癌原发灶的临床及影像学特征构建肺腺癌隐匿性纵隔淋巴结转移的预测模型。方法：回顾性分析
南京医科大学第一附属医院2009—2019年行手术治疗和淋巴结清扫、病理结果为有/无隐匿性纵隔淋巴结转移的肺腺癌患者，
收集患者的多个临床及影像学特征。采用单因素和多因素Logistic回归分析筛选独立预测因子，并构建多个CT特征的影像模
型。建立受试者工作特征（receiver operating characteristic，ROC）曲线评估各模型的预测效能和临床实用价值。结果：在最终
纳入的780例肺腺癌伴大小正常的淋巴结患者中，145例发生淋巴结转移。单因素分析结果提示，肿瘤大小、轴向位置、结节性
质、形态学特征、胸膜牵拉征、胸膜毗邻类型与淋巴结转移显著相关。多因素分析结果提示，肿瘤大小（OR=1.019，95%CI：
1.002~1.036，P=0.028）、结节性质（OR=0.361，95%CI：0.202~0.646，P=0.001）、胸膜牵拉（OR=1.835，95%CI：1.152~2.924，P=
0.011）和纵隔胸膜毗邻（OR=1.796，95%CI：1.106~2.919，P=0.018）是隐匿性纵隔淋巴结转移的独立预测因子。基于预测因子
建立的影像学模型，ROC曲线下面积（area under the curve，AUC）为0.75，灵敏度为86.2%，特异度为53.1%。结论：基于胸部CT
平扫建立的影像学特征模型，在预测肺腺癌隐匿性纵隔淋巴结转移上具有较好的临床价值，可为临床医生的无创性术前决策
及手术治疗方案选择提供依据。
［关键词］ 肺腺癌；肿瘤⁃胸膜关系；隐匿性纵隔淋巴结转移
［中图分类号］ R734.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）04⁃463⁃08
doi：10.7655/NYDXBNSN241402

The clinical value of imaging model based on tumor ⁃ pleura relationship on CT for
predicting occult mediatinal lymph node metastasis in lung adenocarcinoma

1
1
1
2
1
HAO Qinmin ，JIA Yizhen ，LI Hai ，YU Tongfu ，XU Hai ，YUAN Mei 1*
1 Department of Radiology，Department of Pathology，the First Affiliated Hospital of Nanjing Medical University，
2
Nanjing 210029，China
［Abstract］ Objective：To construct a predictive model for occult mediastinal lymph node metastasis in lung adenocarcinoma based
on clinical and imaging features of the primary tumor. Methods：A retrospective analysis was conducted on lung adenocarcinoma
patients，who underwent surgical treatment and lymph node dissection with or without occult mediastinal lymph node metastasis on
pathology at the First Affiliated Hospital of Nanjing Medical University from 2009 to 2019. Multiple clinical and imaging features of the
patient were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors，and an
imaging model incorporating multiple CT characteristics was constructed. Receiver operating characteristic（ROC）curves were
established to evaluate the predictive efficacy and clinical utility value of each model. Results：Among the final 780 patients with
normal⁃sized lymph nodes，145 cases exhibited lymph node metastasis. Univariate analysis suggested that tumor size，axial location，
nodule characteristics，morphological features，pleural pulling sign，and type of pleural adjacency were significantly associated with
lymph node metastasis. Multivariate analysis indicated that tumor size（OR=1.019，95% CI：1.002- 1.036，P=0.028），nodule
characteristics（OR=0.361，95% CI：0.202-0.646，P=0.001），pleural tag（OR=1.835，95%CI：1.152-2.924，P=0.011），and presence of
mediastinal pleural abutting（OR=1.796，95% CI：1.106-2.919，P=0.018）were independent predictors of occult mediastinal lymph

［基金项目］ 江苏省卫生健康委科研项目（K2023057）
通信作者（Corresponding author），E⁃mail：yuanmeijiangsu@163.com（ORCID：0000⁃0002⁃5287⁃9198）
∗