肺癌合并肺梗死患者临床病理特征和预后影响因素  

Clinicopathological features and prognostic factors of patients with lung cancer complicated with pulmonary infarction

作　　者：张锐[1,2,3] 刘崇华 杨奉常 袁双虎 ZHANG Rui;LIU Chonghua;YANG Fengchang;YUAN Shuanghu(Medical Integration and Practice Center,Shandong University,Jinan,Shandong 250100,China;Departmentof Oncology,Linyi People's Hospital,Dezhou,Shandong 251500,China;Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan,Shandong 250117,China;Department of Oncology,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230001,China)

机构地区：[1]山东大学医学融合与实践中心,山东济南250100 [2]临邑县人民医院肿瘤科,山东德州251500 [3]山东省肿瘤防治研究院(山东省肿瘤医院放疗科),山东第一医科大学(山东省医学科学院),山东济南250117 [4]山东省肿瘤防治研究院(山东省肿瘤医院影像科),山东第一医科大学(山东省医学科学院),山东济南250117 [5]中国科学技术大学附属第一医院(安徽省立医院)放疗科,安徽合肥230001

出　　处：《中华肿瘤防治杂志》2024年第12期746-751,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81872475,82073345);济南市临床医学科技创新计划(202019060)。

摘　　要：目的探讨肺癌合并肺梗死患者临床病理特征及预后的影响因素。方法采用描述性病例系列研究的方法。回顾性分析2014-07-01-2021-07-01山东省肿瘤医院收治的105例肺癌合并肺梗死患者的临床资料,以电话、短信和邮件的方式随访患者的生存状况。生存率计算采用Kaplan-Meier法,并用log-rank检验法比较组间的生存率曲线,采用多因素Cox比例风险模型探讨与预后有关的因素。结果105例肺癌合并肺梗死患者中,男76例(72.38%),女29例(27.62%),年龄37~76岁(中位年龄59岁),中位总生存期为12.0(95%CI:6.5~17.5)个月。单因素分析显示,年龄、吸烟史、D-二聚体水平、美国东部肿瘤协作组(ECOG)评分、病理类型、TNM分期、累及肺叶数目与是肺癌合并肺梗死患者预后有关,均P<0.05。多因素分析结果显示,有吸烟史(HR=1.909,95%CI:1.128~3.229,P=0.016)、D-二聚体升高(HR=4.853,95%CI:2.557~9.213,P<0.001)、小细胞癌(HR=2.631,95%CI:1.546~4.479,P<0.001)、累及多个肺叶(HR=2.522,95%CI:1.282~4.962,P=0.007)为患者预后的影响因素。结论肺癌合并肺梗死临床发病相对少见,中心型肺癌、小细胞癌、肿瘤分期T_(3-4)或N_(2-3)等是重要的临床病理特征,其中有吸烟史、D-二聚体升高、小细胞癌、累及多个肺叶患者的预后可能更差。Objective To investigate the clinicopathological features and prognosis of patients with lung cancer complicated with pulmonary infarction.Methods A descriptive case series study was conducted.The clinical data of 105 patients with lung cancer complicated with pulmonary infarction who underwent treatment in Shandong University Cancer Center be-tween 1 July 2014 and 1 July 2021 were analyzed retrospectively.The survival status of the patients was followed up via telephone,text messages,and emails.The survival rate was calculated using the Kaplan-Meier method,and the log-rank test was used to compare the survival curves between groups.A multivariate Cox proportional hazards model was used in to explore the prognostic factors.Results Of the 105 lung cancer patients with pulmonary embolism,76 were male(72.38%)and 29 were female(27.62%),with an age range of 37 to 76 years(median age 59 years).The median overall survival of the whole cohort was 12.0(95%CI:6.5-17.5)months.Univariate analysis revealed that age,smoking history,D-dimer elevation,Eastern Cooperative Oncology Group(ECOG)score,pathological type,TNM stage,the number of lung lobes involved were risk factors for the prognosis of patients with lung cancer complicated with pulmonary infarction(all P<0.05).The results of multivariate analysis showed that smoking history(HR=1.909,95%CI:1.128-3.229,P=0.016),elevated level of D-2 polymer(HR=4.853,95%CI:2.557-9.213,P<0.001),small cell carcinoma(HR=2.631,95%CI:1.546-4.479,P<0.001)and the number of lung lobes involved(HR=2.522,95%CI:1.282-4.962,P=0.007)were factors influencing patient prognosis.Conclusions The clinical onset of lung cancer with pulmonary infarction is relatively rare.Central lung cancer,small cell carcinoma,tumor stage T_(3-4) or N_(2-3),etc.,are important clinical pathological characteristics.Patients with a smoking history,increased D-dimer,small cell carcinoma,and involvement of multiple lobes may have a poorer prognosis.

关 键 词：肺梗死 肺癌 临床病理特征 预后 

分 类 号：R734.2[医药卫生—肿瘤]