摘要
目的分析影响孤立性肺结节(SPN)恶性概率的危险因素。方法检索中国知网(CNKI)、重庆维普数据库(VIP)、万方数据库和Pubmed、EMbase从建库到2018年12月关于SPN良恶性预测模型的原始研究文献。符合纳入标准的文献,由2名研究者进行数据独立提取和质量评价,采用Stata15软件进行统计分析。选择固定效应模型或随机效应模型合并比值比(OR)及95%可信区间(CI)分析文献中纳入的变量,分别采用敏感性分析和Begg's检验漏斗图评估结果的稳定性和文献的发表偏倚。结果共有18篇中英文文献符合标准,对其中19个纳入变量进行Meta分析,结果显示影响SPN良恶性的因素有共有15个:人口学特征因素4个(年龄、肿瘤家族史、既往肿瘤史、吸烟史),影像学特征因素10个[毛刺、结节直径、分叶、钙化、边界清楚、边界模糊、毛玻璃样、胸膜凹陷征、短毛刺、病变最大标准摄取值(SUVmax)],血液生物标志物1个[细胞角蛋白19片段抗原(CYFRA21-1)](P均<0.05)。敏感性分析显示Meta分析结果稳定、可靠;Begg's检验表明这些变量均无发表偏倚。其中年龄、毛刺、结节直径、分叶因素涉及文献较多(超过50%),其余因素涉及文献都小于30%。结论影响SPN良恶性的因素众多,年龄、毛刺、分叶、结节直径为主要影响因素。
Objective To evaluate the risk factors of malignant solitary pulmonary nodules(SPNs).Methods A literature search was conducted was performed using the Chinese CNKI,VIP,Wanfang,PubMed,and Embase databases to identify studies on the prediction model for differentiating benign and malignant SPNs,up to December 2018 A literature search was conducted using the Chinese CNKI,VIP,Wanfang,PubMed,and Embase databases to identify studies on the prediction model for differentiating benign and malignant SPNs,up to December 2018.The meta-analysis was performed using the Stata 15 software.The various factors were analyzed using a fixed-or random-effect model,pooled odds ratio(OR),and 95%confidence interval(CI).A sensitivity analysis was used to evaluate the influence of each study on the strength and stability of the meta-analysis results.The Begg rank correlation test was conducted to assess publication bias.Results Eighteen studies met our inclusion criteria.The meta-analysis revealed that 19 factors,including 4 demographic characteristic-related factors(patient age,family history of cancer,and histories of cancer and smoking),10 imaging characteristic-related factors(spiculation,SPN diameter,lobulation,calcification,ground-glass nodule,clear boundary,obscure boundary,pleural indentation sign,short spiculation,and SUVmax),and 1 biomarker(CYFRA21-1;all P<0.05),influenced the development of malignant SPN.The sensitivity analysis revealed that the study was stable and reliable,and no publication biases for all the variables.Age,spiculation,SPN diameter,and lobulation were chosen as prediction models in≥9 studies(50%),and the other factors only existed in<30%studies.Conclusions Numerous factors can affect the development of malignant SPNs,with age,spiculation,SPN diameter,and lobulation being the main influencing factors.
作者
张凯
阴建
孙萍
佟赫
Zhang Kai;Yin Jian;Sun Ping;Tong He(Department of Cancer Prevention,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Cancer Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华健康管理学杂志》
CAS
CSCD
2019年第5期400-405,共6页
Chinese Journal of Health Management
基金
中国医学科学院医学与健康科技创新工程项目(2017-I2M-1-006)。
关键词
META分析
孤立性肺结节
肺结节
肺癌
预测模型
Meta-analysis
Solitary pulmonary nodule
Pulmonary nodule
Lung cancer
Prediction model
作者简介
通信作者:张凯,Email:kai87968@sina.com,电话:13901087968。
