肺原位腺癌和微浸润腺癌489例的临床病理与预后分析  

Clinicopathology and prognosis of 489 patients with adenocarcinoma in situ and minimally invasive adenocarcinoma of lung

作　　者：李予林 陈志军[1] 喻微[1] 张永奎[1] 

机构地区：[1]浙江省舟山医院心胸外科,浙江舟山316021

出　　处：《中国胸心血管外科临床杂志》2017年第6期445-449,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨肺癌中原位腺癌(AIS)与微浸润腺癌(MIA)的临床病理特征及其治疗策略。方法回顾性分析我院2007年1月至2015年8月489例AIS和MIA患者的临床资料,其中男122例、女367例,平均年龄26~78(51±9)岁。根据病理类型,分为AIS组(246例)和MIA组(243例),其中AIS组男60例、女186例,平均年龄(50±7)岁;MIA组男62例、女181例,平均年龄(54±5)岁。对比两组患者临床病理特征、手术方式及预后。结果 AIS与MIA患者在年龄、癌胚抗原(CEA)指标、结节形态、结节大小上差异均有统计学意义(P<0.05)。AIS患者大多为60岁以下的患者,肿瘤标志物中CEA指标一般在正常范围,且CT上常表现为直径1 cm以内的纯磨玻璃结节,而MIA的CT表现常为直径小于1.5 cm的混合磨玻璃结节,更常伴有支气管扩张和胸膜凹陷征。AIS组及MIA组的5年无瘤生存率均达到100%,并且亚肺叶切除(包括肺段切除及楔形切除)与肺叶切除、系统性淋巴结清扫与纵隔淋巴结采样对患者的预后差异并无统计学意义。结论术前临床及影像学特征分析可以对AIS及MIA这两种组织学亚型进行预判,从而为患者个体化手术及术后治疗方案的制定提供帮助。Objective To investigate the clinical and pathological characteristics, prognosis and treatment strategies of adenocarcinoma in situ （AIS） and minimally invasive adenocarcinoma （MIA）. Methods We retrospectively analyzed the clinical data of 489 patients with AIS and MIA in our hospital from January 2007 to August 2015. There were 122 males and 367 females with an average age of 26-78 （51±9） years. According to the pathological types, they were divided into the AIS group （246 patients） and the MIA group （243 patients）. In the AIS group, there were 60 males and 186 females with an average age of 50±7 years. In the MIA group, there were 62 males and 181 females with an average age of 54±5 years. The clinicopathological features, surgical methods and prognosis of the two groups were compared. Results There were significant differences in age, value of carcino-embryonic antigen （CEA）, nodule shape and nodule size between the AIS and MIA groups （P〈0.05）. AIS patients were mostly under the age of 60 years with the value of CEA in the normal range which often appeared as pure ground-glass opacity lung nodules 〈 1 cm in diameter on the CT scan. MIA often appeared as mixed ground-glass nodules 〈 1.5 cm in diameter, accompanied by bronchiectasis and pleural indentation. The 5-year disease-free survival rate of the AIS and MIA groups reached 100%, and there was no statistical difference in the prognosis between the two groups after subtotal lobectomy （pulmonary resection and wedge resection） and lobectomy, systematic lymph node dissection and mediastinal lymph node sampling. Conclusion The analysis of preoperative clinical and imaging features can predict the AIS and MIA and provide individualized surgery and postoperative treatment program.

关 键 词：肺腺癌 原位腺癌 微浸润腺癌 临床病理 预后 

分 类 号：R734.2[医药卫生—肿瘤]