单肺移植术后自体肺肺癌的临床病理特征和预后分析  

Clinicopathological characteristics,prognosis and related factors of lung cancer arising in the native lung following single lung transplantation

作　　者：刘宏艳[1] 程娜 郭丽娟 郭润财 毛美玲 郭嘉 赵芮松 王蓓[1] 钟定荣 Liu Hongyan;Cheng Na;Guo Lijuan;Guo Runcai;Mao Meiling;Guo Jia;Zhao Ruisong;Wang Bei;Zhong Dingrong(Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Lung Transplantation,Respiratory Center,China-Japan Friendship Hospital,Beijing 100029,China;Department of Diagnostic Radiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院病理科,北京100029 [2]中日友好医院呼吸中心肺移植科,北京100029 [3]中日友好医院放射诊断科,北京100029

出　　处：《中华结核和呼吸杂志》2025年第4期358-364,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中国医学科学院医学与健康科技创新工程(2023-I2M-C&T-B-120)。

摘　　要：目的:探讨终末期肺疾病患者单肺移植术后自体肺发生肺癌的临床病理特征及预后。方法:回顾性分析2017年9月至2021年6月中日友好医院247例单肺移植术受者中12例自体肺发生肺癌患者的临床、病理及随访资料,其中男11例,女1例,年龄46~67(59.25±5.75)岁。分析患者临床病理特征与预后的相关因素。结果:12例受者中11例移植前有吸烟史,移植前肺原发疾病包括特发性肺纤维化8例,结缔组织病相关性肺间质病3例和慢性阻塞性肺病1例,移植到自体肺继发肺癌的时间间隔为3~53(30.0±16.2)个月,11例确诊肺癌时相关的肿瘤标志物升高,胸部CT和(或)PET-CT显示自体肺新发结节或高FDG摄取结节。12例肺癌组织学类型包括1例小细胞癌和11例非小细胞肺癌(7例鳞状细胞癌,3例腺癌和1例SMARCA4缺失型未分化癌)。临床分期Ⅳ期8例,Ⅲ期1例,Ⅰ期3例;3例Ⅰ期和1例Ⅲ期患者接受手术治疗,Ⅳ期患者采用放、化疗和姑息疗法。随访至2024年9月,10例死亡,1例生存,1例失访,中位生存时间7个月(2~47个月),1年累积生存率为9.2%。结论:单肺移植后自体肺患肺癌的发病风险增加,预后极差,组织学类型大多数为鳞状细胞癌,对移植后高危人群密切监测早期发现肿瘤可能会延长生存时间。Objective:To explore the clinicopathological characteristics and prognosis of lung cancer arising in the native lung after single lung transplantation for end-stage lung disease.Methods:We conducted a respective analysis of the clinical,pathological,and follow-up data of 12 recipients who developed lung cancer in the native lung after single-lung transplantation at China-Japan Friendship Hospital from September 2017 to June 2021,among a total of 247 single-lung transplantations performed during this period.Eleven were male and 1 was female,with ages ranging from 46-67(59.25±5.75)years.Results:Of the 12 recipients,11 had a smoking history before transplantation.The underlying diagnosis of lung diseases before transplantation included 8 cases of idiopathic pulmonary fibrosis,3 cases of connective tissue disease-associated interstitial lung disease,and 1 case of chronic obstructive pulmonary disease.The time interval from transplantation to the development of lung cancer in the native lung was 3 to 53 months,with an average of(30.0±16.2)months.Eleven patients had elevated levels of serum tumor markers at the time of lung cancer diagnosis.CT/PET-CT showed new nodules or FDG avidity in the native lung.The histological types of lung cancer in the 12 cases included 1 case of small cell carcinoma and 11 cases of non-small cell lung cancer(7 cases of squamous cell carcinoma,3 cases of adenocarcinoma,and 1 case of SMARCA4-deficient undifferentiated carcinoma).There were 8 cases in clinical stageⅣ,1 case in stageⅢ,and 3 cases in stageⅠ.Three patients in stageⅠand one patient in stageⅢunderwent surgical treatment,while patients in stageⅣwere treated with radiotherapy,chemotherapy,and palliative care.At the end of this study,10 patients had died,1 patient survived,and 1 patient was lost to follow-up.The median survival time was 7 months(ranging from 2 to 47 months),and the 1-year cumulative survival rate was 9.2%.Conclusions:The risk of developing lung cancer in the native lung after single lung transplantation

关 键 词：肺移植 自体肺 肺癌 特发性肺间质纤维化 

分 类 号：R734.2[医药卫生—肿瘤]