基于2015年WHO新分类的93例大细胞肺癌临床病理分析  

Large-cell lung carcinoma by the 2015 WHO classification： a clinicopathologic analysis of 93 cases

作　　者：张静渊[1] 徐新宇[2] 沈勤[1] 王艳芬[1] 王璇[1] 司晓军 

机构地区：[1]南方医科大学南京临床学院/南京军区南京总医院病理科,210002 [2]江苏省肿瘤医院病理科

出　　处：《中华病理学杂志》2016年第4期231-236,共6页Chinese Journal of Pathology

摘　　要：目的根据2015年WHO肺、胸膜、胸腺、心脏肿瘤分类提出的大细胞肺癌（LCC）分型标准，分析93例LCC各亚型的临床病理学特点。方法回顾性分析1634例经手术切除的非小细胞肺癌中93例LCC的临床病理特点和免疫组织化学特点，并结合生存情况进行分析。结果93例LCC中实体型腺癌50例（53．8％），非角化型鳞状细胞癌21例（22．6％），腺鳞癌表型3例（3．2％），免疫组织化学表型不明确者8例（8．6％），裸免疫表型11例（11．8％）。LCC各免疫表型间的临床特征差异并不显著。人选病例1、3、5年的总体生存率为51．0％、5．4％和1．1％；中位生存期为（15．2±1．2）个月（95％CI12．88～17．55），其中裸免疫表型者预后最差，1年生存率仅为18％，与实体型腺癌或非角化型鳞癌相比差异有统计学意义（P〈0．05）。结论免疫组织化学分型取代了原有的形态学分型成为LCC新分型的基础，其中裸免疫表型的预后最差，可能代表着一类独特的真正意义上的未分化癌。Objective To analyze the clinicopathologic characteristics of large-cell lung carcinoma （LCC） subtypes according to the 2015 WHO classification. Methods A total of 93 cases of LCC were identified among 1 634 cases of morphologically undifferentiated non-small cell lung carcinoma. Clinicopathologic and immunohistochemical characteristics were retrospectively reviewed. Results Among 93 cases of LCC, 50 cases were solid adenocarcinoma （53.8%） , 21 cases were non-keratinzing squamous cell carcinoma （22. 6% ）, 3 cases were adenosquamous carcinoma （3.2%）, 8 cases were large cell carcinoma with unclear immunohistochemical features （8.6%） , and 11 cases were large cell carcinoma with null immunohistochemical features （11.8%）. No significant differences in clinical features were found among various immunophenotypes. The overall survival of 1, 3 and 5 years of all cases was 51.0% , 5.4% and 1.1% , respectively and the mean survival was （15.2 ±1.2）months. Notably the null type had the lowest survival rate of 18% in one year, significantly worse than those of solid adenocarcinoma and non-keratinzing squamous cell carcinoma. Conclusions The 2015 WHO classification based on immunohistochemical phenotype replaces the morphological approach in separating poorly differentiated non-small cell lung carcinoma from the former large cell lung carcinoma. The null immunohistochemical subtype may represent a distinct subtype of undifferentiated carcinoma with the worst prognosis.

关 键 词：肺肿瘤 癌 大细胞 免疫组织化学 免疫表型分型 预后 

分 类 号：R734.2[医药卫生—肿瘤]