31例原发性肺肉瘤样癌临床分析  

Clinical analysis of primary lung sarcomatoid carcinoma in 31 cases

作　　者：张悦[1] 郭雪君[1] 韩锋锋[1] 皮卫峰[1] 孙晋渊[1] 

机构地区：[1]上海交通大学医学院附属新华医院呼吸科,200092

出　　处：《国际呼吸杂志》2016年第1期6-11,共6页International Journal of Respiration

摘　　要：目的通过分析原发性肺肉瘤样癌（LSC）临床资料，探讨其特征和影响预后的因素。方法回顾性分析我院2006年1月至2013年12月收治的31例经病理证实的LSC患者的临床资料。采用SPSS18．0统计软件对患者性别、年龄、吸烟史、肿瘤大小、病理类型、TNM分期和治疗等因素进行预后分析。用Kaplan-Meier法进行生存分析，用Log—rank法进行单因素分析，用Cox比例风险回归模型进行多因素分析。结果患者表现为咳嗽、咯血、胸痛，其症状与其他类型肺癌相似，但其增强CT有一定特征性。患者1、2、3年总生存率分别为51．6％、29．0％、9．7％，中位生存时间为1．07年。单因素分析显示，肿瘤大小（x2=4．869，P=0．027）、T分期（x2=11．504，P=0．001）、有无淋巴结转移（x2=17．978，P=0．000）、TNM分期（x2=14．147，P=0．000）、治疗方法（x2=10．202，P=0．006）及肿瘤病理类型（x2=13．388，P=0．OlO）是影响预后的因素。多因素分析显示肿瘤大小、T分期、N分期是影响预后的独立因素。结论LSC是一类少见的分化较差的非小细胞肺癌，较一般肺癌更具侵袭性，预后差。本病缺乏特异性临床表征，增强CT扫描有一定特征性，但诊断主要依靠病理。手术是LSC的首选治疗方法。肿瘤大小、T分期、N分期是影响预后的独立因素。Objective To analyze clinical data of primary lung sarcomatoid carcinoma （LSC） and investigate the characteristics and the corresponding prognosis factors. Methods The clinical data of 31 patients with pathology-confirmed LSC in our hospital from January 2006 to December 2013 were retrospectively analyzed. The correlation between prognosis and sex, age, smoking history, tumor size, histological type, TNM staging, and treatment was analyzed by the statistical software SPSS 18.0. The survival analysis was conducted using the Kaplan-Meier method. The factors influencing survival were analyzed using univariate （Log-rank） and multivariate （Cox） models. Results The patientsr clinical manifestations included tussis, hemoptysis, and chest pain, which were similar to those of other types of lung cancer, while there were some characteristic findings on enhancement CT scan. The overall one-, two-, and three-year survival rate was 51.6%, 29.0~ and 9.7%, respectively. The median survival time was 1.07 years. Univariate analysis revealed that tumor size （X2~ 4. 869, P ~ 0. 027）, T stage （Xz= 11. 504, P = 0. 001 ）, lymph node metastasis or not （ Z2 ^-~ ] 7.978, P = 0. 000）, TNM stage （ ）~z ~ 14. 147, P = 0. 000）, treatment （ ）~2 ~ 10. 202, P ： 0. 006）, and histological type （ ：~2 ~ 13. 388, P ~ 0. 010） were prognostic factors. Cox multivariate analysis found that tumor size, T stage, N stage were independent prognostic factors for LSC. Conclusions LSC is a very rare and aggressive subtype of non-small cell lung cancer,which is more aggressive and has a poorer prognosis than ordinary lung carcinoma. It has no specific clinical feature. Although LSC has some relatively characteristic imaging findings, it＇s dependent on pathologic examination to establish the diagnosis. Surgery is the first choice. Tumor size, T stage, N stage are independent prognostic factors for LSC.

关 键 词：肺肿瘤 肉瘤样癌 临床特征 预后因素 

分 类 号：R734.2[医药卫生—肿瘤]