病理T1期浸润性肺腺癌不同病理亚型的临床特征及其预后分析

doi:10.16150/j.1671-2870.2018.01.015

摘要/Abstract

摘要： 目的：研究T₁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,Log-Rank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：T₁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。

关键词: 肺腺癌, T₁期, 预后, 病理亚型, 临床特征

Abstract: Objective: To study the clinicopathological features and prognostic significance of different pathological subtypes of T₁ invasive lung adenocarcinoma 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 enrolled. 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 difference. COX regression analysis was used to determine the risk factors of prognosis. Result: There were no significant differences in age, sex, CEA level and tumor differentiation between the five groups（P>0.05）. Meanwhile, there were significant differences in invasion of visceral pleura, lymph node metastasis, TNM stage and recurrence or metastasis after operation 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 pathological 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 node metastasis. Micro-papillary subtypes indicate higher lymph node metastasis and poor prognosis. More aggressive treatment and observation might be needed after operation of micro-papillary subtype of invasive lung adenocarcinoma.

Key words: Lung adenocarcinoma, T₁, Prognosis, Pathological subtype

中图分类号:

R734.1

杜海磊, 车嘉铭, 朱良纲, 李鹤成, 杭钧彪. 病理T₁期浸润性肺腺癌不同病理亚型的临床特征及其预后分析[J]. 诊断学理论与实践, 2018, 17(01): 82-86.

DU Hailei, CHE Jiaming, ZHU Lianggang, LI Hecheng, HANG Junbiao. Clinical characteristics of different pathological subtypes of T₁ invasive lung adenocarcinoma and analysis of prognosis[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(01): 82-86.

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病理T₁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 T₁ invasive lung adenocarcinoma and analysis of prognosis

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