肺大细胞神经内分泌癌22例临床分析  

Clinical Analysis of 22 Cases of Pulmonary Large Cell Neuroendocrine Cancer

作　　者：钱哲[1] 胡瑛[1] 郑华[1] 董宇杰[2] 王群慧[1] 李宝兰[1] 

机构地区：[1]首都医科大学附属北京市胸科医院,北京市结核病胸部肿瘤研究所综合科,北京101149 [2]首都医科大学附属北京市胸科医院,北京市结核病胸部肿瘤研究所病理科,北京101149

出　　处：《中国肺癌杂志》2016年第2期82-87,共6页Chinese Journal of Lung Cancer

摘　　要：背景与目的肺大细胞神经内分泌癌是肺原发恶性肿瘤的一种少见类型,由于其特殊的生物学行为、复杂的病理学标志、多样的影像学表现及欠佳的治疗疗效,亟待进行临床探讨。本研究旨在分析肺大细胞神经内分泌癌的临床资料,为进一步提高其诊治水平提供依据。方法回顾性分析22例肺大细胞神经内分泌癌患者的临床特征、诊治情况及预后。结果肺大细胞神经内分泌癌好发于有大量吸烟史的老年男性,临床表现以咳嗽、咳痰、咯血、胸痛为主。计算机断层扫描(computed tomography,CT)表现以周围型肿块为主,可伴不均匀强化和坏死。免疫组化神经内分泌分化标志物Syn、Cg A和CD56的阳性表达率分别为72.7%、68.2%和68.2%。17例行手术治疗,术后10例接受辅助治疗,5例行姑息化疗。单因素分析提示吸烟指数(P=0.029)、淋巴结转移(P=0.034)、肿瘤-淋巴结-转移(tumor-node-metastasis,TNM)分期(P=0.005)、治疗方法(P=0.047)、术后辅助化疗(P=0.014)是预后的影响因素,多因素分析提示淋巴结转移(P=0.045)及术后辅助化疗(P=0.024)是预后的影响因素。结论肺大细胞神经内分泌癌缺乏特异性的临床表现,确诊依赖术后病理,各种治疗疗效欠佳。淋巴结转移状态及术后辅助化疗是影响预后的重要因素。Background and objective Pulmonary large cell neuroendocrine carcinoma （LCNEC） is a rare pri- mary malignant tumor. Due to poor understanding of its biologic behaviors, pathological features, image manifestations and clinical effects, clinical study is urgent. Analysis of clinical data of pulmonary LCNEC, in order to improve the clinical diagnosis and treatment. Methods Retrospective analysis of 22 pulmonary LCNEC cases of clinical features, diagnosis, treatments and prognosis. Results Pulmonary large cell neuroendocrine carcinoma occurs in older men with heavy smoking history., clinical symptoms are cough, sputum, hemoptysis, and chest pain. Computed tomography （CT） features are peripheral mass mainly, accompanied by heterogeneous density and necrosis. Immunohistochemical neuroendocrine differentiation markers Syn, CgA and CD56 positive expression rates were： 72.7%, 68.2% and 68.2%, respectively. 17 patients underwent surgical treatment, 10 patients received adjuvant therapy, 5 underwent palliative chemotherapy. Univariate analysis indicated that smoking index （P=0.029）, lymph node metastasis （P=0.034）, tumor-node-metastasis （TNM） stage （P=0.005）, treatment （P=0.047）, post- operative chemotherapy （P=0.014） are prognostic factors. Multivariate analysis showed that lymph node metastasis （P=0.04S） and postoperative chemotherapy （P=0.024） are prognostic factors. Conclusion Pulmonary LCNEC is lack of specific clinical symptoms, and its pathological diagnosis depends on postoperative specimens, poor efficacy of various treatments is its current situation. Lymph node metastasis and postoperative chemotherapy are important prognostic factors.

关 键 词：肺肿瘤 临床特征 免疫组化 预后 

分 类 号：R734.2[医药卫生—肿瘤]