病理T_1期浸润性肺腺癌不同病理亚型的临床特征及其预后分析  

Clinical characteristics of different pathological subtypes of T_1 invasive lung adenocarcinoma and analysis of prognosis

作　　者：杜海磊[1] 车嘉铭[1] 朱良纲[1] 李鹤成[1] 杭钧彪[1] DU Hailei;CHE Jiaming;ZHU Lianggang;LI Hecheng;HANG Junbiao(Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, Chin)

机构地区：[1]上海交通大学医学院附属瑞金医院胸外科,上海200025

出　　处：《诊断学理论与实践》2018年第1期82-86,共5页Journal of Diagnostics Concepts & Practice

基　　金："研究型医师"以及"临床专职科研队伍"项目(20172005)

摘　　要：目的 :研究T_1期浸润性肺腺癌5种常见病理亚型的临床病理特征及其对预后的影响,为肺腺癌临床监测及治疗提供参考。方法:纳入上海交通大学医学院附属瑞金医院2009年1月至2011年1月间行肺癌手术,且术后经病理检查证实为浸润性肺腺癌、肿瘤直径≤3 cm的患者,分别选取贴壁状为主型、腺泡为主型、乳头状为主型、微乳头状为主型、实性为主型各24例,5组共计120例。对患者的临床病理资料包括年龄、性别、癌胚抗原(carcinoembryonic antigen,CEA)水平、肿瘤分化程度、病理亚型等进行回顾性分析,应用Kaplan-Meier法计算生存率,LogRank检验比较生存差异;多因素COX回归分析判定预后的危险因素。结果 :5组不同病理亚型肺腺癌患者的年龄、性别、癌胚抗原(carcinoembryonic antigen,CEA)水平、肿瘤细胞分化程度差异均无统计学意义(P>0.05),而5组间的胸膜浸润、有无淋巴结转移、术后TNM分期及术后有无复发进展情况差异有统计学意义(P<0.05)。5种肺腺癌亚型中,微乳头状为主型的淋巴结转移率(62.5%)和术后复发转移率(41.6%)最高。进一步行生存率分析显示,贴壁状为主型患者的预后最好,5年生存率为96.0%,微乳头状为主型患者预后最差,5年生存率为66.7%,2组间差异有统计学意义(P<0.05)。病理亚型、淋巴结转移情况、术后TNM分期是影响T1期浸润性肺腺癌患者预后的危险因素,且病理亚型、淋巴结转移情况还是影响其预后的独立危险因素(OR均>1)。结论:T_1期浸润性肺腺癌患者的预后与其病理亚型有关,而其中微乳头状为主亚型患者有着较高的淋巴转移率和更差的预后,对于该亚型的T1期浸润性肺腺癌患者,在术后可能需采取更积极的治疗和严密观察。Objective： To study the elinicopathological features and prognostic significance of different pathological subtypes of T1 invasive lung adenoearcinoma for providing a reference for the monitoring and treatment strategy of lung adenocarcinoma. Methods： A total of 120 patients undergone surgical treatment and confirmed by postoperative pathology as invasive lung adenocarcinoma with tumor diameter less than or equal to 3 cm from Jan. 2009 to Jan, 2011 were en-rolled. The patients were divided into five groups according to dominant pathological subtypes： lepidic group, acinar group, papillary group, micro-papillary group, and solid group. The clinical and pathological data of the patients were analyzed retrospectively. Kaplan-Meier method was used to calculate survival rate. log-Rank test was used to compare survival dif-ference. COX regression analysis was used to determine the risk factors of prognosis. Result： There were no significant dif-ferences in age, sex, CEA level and tumor differentiation between the five groups （P〉0.05）. Meanwhile, there were signifi-cant differences in invasion of visceral pleura, lymph node metastasis, TNM stage and recurrence or metastasis after oper-ation between the five groups （P〈0.05）. Among the five subtypes, lymph node metastasis rate （62.5%） and postoperative recurrence rate （41.6%） were the highest in micro-papillary group. Survival analysis showed that lipidic group had the best prognosis, the 5 year survival rate was 96.0%; the prognosis of micro-papillary group was the worst, and the 5 year survival rate was 66.7%. The difference was statistically significant （P〈0.05）. Pathological subtypes, lymph node metastasis and TNM staging were the risk factors influencing the prognosis of stage T1 invasive lung adenocarcinoma. Different pathologi-cal subtypes and lymph node metastasis were the independent prognostic factors （OR〉1）. Conclusions： The prognosis of T1 invasive adenocarcinoma of lung is related to pathological subtype and lymph nod

关 键 词：肺腺癌 T1期 预后 病理亚型 临床特征 

分 类 号：R734.1[医药卫生—肿瘤]