细支气管肺泡癌184例临床分析  

Clinical analysis of 184 patients with bronchioloalveolar cell carcinoma

作　　者：葛楠[1] 李龙芸[1] 缪若羽[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸科,北京100730

出　　处：《癌症进展》2008年第3期269-277,共9页Oncology Progress

摘　　要：目的探讨细支气管肺泡癌(bronchioloalveolar cell carcinoma,BAC)的临床症状、诊断、误诊、病理类型、影像学特点、治疗方案及预后。方法用统计学方法回顾性分析北京协和医院1990年1月到2005年12月期间收治的经病理证实的184例细支气管肺泡细胞癌。结果本组病例占我院同期原发性支气管肺癌的5.2%(184/3534),占我院同期肺腺癌的14.5%(184/1265),男女之比为1:1.22;易误诊为肺炎、肺结核、间质性肺病,误诊率57%;中位生存期为6.48年(77.76个月);性别、临床分期、病理类型、影像学类型、治疗方案的组间生存曲线有统计学意义(P≤0.05);不同的病理类型、影像学类型、治疗方案是影响预后的因素。结论细支气管肺泡细胞癌与其他非小细胞肺癌亚型相比有自己的特点。本组BAC发病率男女比例相似;咳大量泡沫样痰在BAC中并不多见,但对诊断有提示意义;由于影像学上的多样性易被误诊,以致延误治疗;相对于其他非小细胞肺癌有较长的生存期;对BAC的治疗应尽可能手术为主,再结合化疗、放疗、分子靶向治疗的综合治疗为原则;EGFR-TKI的一线治疗可用于晚期BAC。Objective To investigate the clinical symptoms, diagnoses and misdiagnoses, pathological and radiological characteristics, treatment modes, and prognoses of bronchioloalveolar cell carcinoma （BAC）. Methods We retrospectively analyzed the clinical data of 184 BAC patients who were admitted to Peking Union Medical College Hospital （PUMCH） from January, 1990 to December, 2005. Results The enrolled cases in this study accounted for 5.2% （184/3534） of patients with primary bronchiogenic carcinomas and 14. 5% （184/1265 ） of patients with pulmonary adenocarcinomas who were admitted by PUMCH during the same period. The ratio of males to females was 1 ：1.24. BAC was misdiagnosed as pneumonia, pulmonary tuberculosis or interstitial lung disease, and the percentage of the misdiagnosed cases was 57%. The median overall survival （OS） was 6.48 years （77.76 months）. The survival was correlated with gender, clinical stage, pathological type, radiological type, and treatment mode （P 〈0. 05）. Factors that influenced prognosis included pathological type, radiological type, and treatment mode. Conclusion The incidence of BAC is similar between men and woman. Bronchorrhea is not commonly seen in BAC; however, it may provide certain clues for diagnosis. Because of the radiological diversity, BAC may be misdiagnosed. Nevertheless, its overall survival is relatively long. Surgery remains the primary treatment method, supplemented by chemotherapy, radiotherapy, and molecular targeted therapy.

关 键 词：细支气管肺泡细胞癌 治疗 预后 生存期 

分 类 号：R734.1[医药卫生—肿瘤]