同时性多中心原发性肺癌37例临床病理分析  

Clinicopathologic analysis of 37 cases of synchronous multiple primary lung cancer

作　　者：何萍[1,2] 顾霞[2] 关玉宝[3] 姚广裕[4] 林云恩[2] 何建行[5] 

机构地区：[1]南方医科大学研究生学院临床医学系,广东广州510515 [2]广州医学院第一附属医院病理科,广东广州510120 [3]广州医学院第一附属医院放射科,广东广州510120 [4]南方医科大学南方医院乳腺中心,广东广州510515 [5]广州医学院第一附属医院胸外科,广东广州510120

出　　处：《中华肿瘤防治杂志》2013年第5期357-360,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：广州医学院青年科研项目(2012A05)

摘　　要：目的:分析同时性多中心原发性肺癌的发病率、临床病理特征及预后。方法:回顾2005-01-01-2011-12-30经手术切除2 284例原发性肺癌,筛选其中经临床、病理及影像诊断为同时性多中心原发性肺癌37例。对年龄、性别、吸烟状态、临床分期及肿瘤数目、位置和大小等变量与同时性多中心原发性肺癌预后的关系进行Kaplan-meier生存分析检验。结果:同时性多中心原发性肺癌的发病率占同期肺癌的1.62%(37/2 284),中位年龄60岁。病理类型以腺癌为主,相同病理类型者占86.49%(32/37)。病理类型相同者诊断需在多个癌灶见到原位癌区域;影像表现为肿块边缘不光整,分叶状,有毛刺征。术后3年生存率78.38%,临床分期与预后相关,肿瘤最大径≤3cm与>3cm者预后差异有统计学意义,P=0.0000。结论:同时性多中心原发性肺癌的发病率较低,多为腺癌,相同病理类型者需结合病理及影像与肺内转移瘤鉴别。手术为首选治疗手段,肿瘤最大径≤3cm、pT1、pN0者预后较好。OBJECTIVE.. To analyze the incidence, clinical features and prognosis of synchronous multiple primary lung cancer. METHODS： Retrospective analysis was performed on 37 cases of synchronous multiple primary lung cancer diagnosed by pathological and radiological examination among 2 284 cases of primary lung cancer during 2005-01-01- 2011-12-30. Kaplan-meier survival analysis was used to assess the prognostic significance of clinical parameters including age,gender, smoking, staging, tumor number, location and size. RESULTS.. The synchronous multiple primary lung cancer accounted for 1.62 % （37/2 284） of lung cancer during the same period. Median age was 60 years old. Adenocarcinoma was the predominantly pathological type and which accounted for 86.49 % （32/37） of all cases. The diagnostic protocol of syn- chronous multiple primary lung cancer was based on the combination of histological and radiographic analysis. The pres- ence of carcinoma in situ and imaging sign of lobulated and spicule form support the diagnosis of multiple primary lung cancer. Three-year survival rates was 78.38%. Staging was associated with survival and patients with a tumor 〉3 cm had a worse prognosis than patients with a tumor 〈3 cm （P= 0. 000 0）. CONCLUSIONS.. The incidence of synchronous mul- tiple primary lung cancer is relatively low and adenocarcinoma is the dominant pathological type in most cases. In the case of same histologic conditions,it is very important to differentiate synchronous multiple primary lung cancer from pulmona- ry metastasis. An aggressive surgical approach offers the greatest chance for long-term survival in patient with synchro- nous multiple primary lung cancer and there is a better prognosis in patients with a tumor 〈3 cm and staging of pT~ and pNo.

关 键 词：多中心原发性肺癌 腺癌 病理 预后 

分 类 号：R734.2[医药卫生—肿瘤]