肺腺鳞癌的临床病理和分子生物学特征及其预后影响因素分析  

The clinical and pathological features, biomarker characteristics and prognosis analysis of lung adenosquamous carcinoma

作　　者：周生余 薛奇 应建明 胡兴胜 杨建良 林华 石远凯 Zhou Shengyu;Xue Qi;Ying Jianming;Hu Xingsheng;Yang Jianliang;Lin Hua;Shi Yuankai(Department of Medical Oncology,Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medieal Sciences and Peking Union Medical College,Beijing 100021,China;Department of Thoracic Surgery,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 Pathology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Outpaticnt Medical Records Room,National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021, China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤内科/抗肿瘤分子靶向药物临床研究北京市重点实验室,100021 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院胸外科,100021 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院病理科,100021 [4]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院病案室,100021

出　　处：《中华肿瘤杂志》2019年第1期50-55,共6页Chinese Journal of Oncology

摘　　要：目的探讨肺腺鳞癌的临床病理特征、分子生物学特征及其预后影响因素。 方法回顾性分析2007年8月至2017年7月就诊于中国医学科学院肿瘤医院的133例肺腺鳞癌患者的临床资料。133例患者中,男64例,女69例。分析患者的临床病理特征、分子生物学特征、生存情况及其预后影响因素。 结果133例患者中,吸烟81例(60.9%),可明确腺鳞癌成分含量62例(以腺癌为主45例,以鳞癌为主17例)。55例患者就诊时已出现淋巴结转移。全组患者均接受过至少1种肿瘤驱动基因检测,表皮生长因子受体(EGFR)突变率为50.8%(67/132),K-ras突变率为8.6%(11/128),间变性淋巴瘤激酶阳性率为4.2%(2/48)。性别、吸烟状态和腺鳞癌成分比例与患者的EGFR突变状态均有关(均P<0.05)。全组患者的中位生存时间为28个月,1、3、5年生存率分别为72.9%、23.3%和9.0%。接受EGFR酪氨酸激酶抑制剂治疗是影响患者预后的独立因素(P=0.024)。 结论肺腺鳞癌恶性程度高、预后差,早期诊断和基于驱动基因的个体化治疗有利于改善肺腺鳞癌患者的生存状况。Objective Adenosquamous carcinoma of lung is an uncommon subtype with more aggressive behavior and poor prognosis than adenocarcinoma and squamous cell carcinoma. This study was aimed to investigate the clinicopathological characteristics and prognostic factors of lung adenosquamous carcinoma. Methods The pathological features and follow-up data of 133 patients were collected and the prognostic factors of these patients were retrospectively analyzed. Results Among the 133 patients, 81 cases (60.9%) smoked. Among the 62 patients whose percentage of histological components were identified, 45 cases had >50% adenocarcinoma components, and 17 cases had >50% squamous cell carcinoma components. 55 patients had lymph node metastasis at the first visit. All patients accepted at least one test of tumor driven gene mutation, and the results showed that the mutation rate of EGFR was 50.8% (67/132), the mutation rate of K-ras was 8.6% (11/128), the ALK-positive rate was 4.2% (2/48). The gender, smoking status, and the proportion of pathological components were the main influence factors of EGFR mutation status. The median overall survival was 28 months, the rates of 1-year, 3-year, and 5-year survival were 72.9%, 23.3%, and 9.0%, respectively. EGFR tyrosine kinase inhibitors (TKIs) treatment was an independent risk factor for prognose of these patients (P=0.024). Conclusions Lung adenosquamous carcinoma is a rare subtype with high malignancy and poor prognosis. Early diagnosis and driven-mutation-based individualized therapy may improve the survival of patients with lung adenosquamous carcinoma.

关 键 词：肺腺鳞癌 驱动基因 表皮生长因子受体 预后 

分 类 号：R734.2[医药卫生—肿瘤]