含梭形／巨细胞肺癌28例临床病理特征及预后分析

摘要

目的：探讨含梭形／巨细胞肺癌（lung carcinoma with spindle ／giant cells，LCSG）的临床病理特征和预后。方法：回顾性总结分析1985年9月至2009年7月就诊的28例 LCSG 的临床和组织病理学资料。利用生存曲线进行生存分析，Cox 风险比例模型分析影响预后的因素。结果：LCSG 患者男女比例为11∶3，年龄33～73岁，中位年龄60岁；pTNM分期：Ⅰ期8例，Ⅱ期7例，Ⅲ期11例，Ⅳ期2例；病理类型：含梭形细胞癌11例，其中单纯梭形细胞癌2例，梭形细胞癌伴鳞癌5例、伴腺癌3例和伴腺鳞癌及大细胞癌1例；含巨细胞癌17例，其中单纯巨细胞癌13例，巨细胞癌伴鳞癌1例、伴腺癌3例。单纯肉瘤样细胞型患者的中位生存期较混合有上皮样细胞型者长（22．8个月 vs 8．0个月，P ＝0．022）。单因素分析显示，年龄（P ＝0．002）、肿瘤大小（P＝0．005）、组织学类型（P ＝0．001）、pTNM分期（P ＝0．015）、T 分期（P ＝0．008）、淋巴结转移（P ＝0．013）和 M分期（P ＝0．000）是影响 LCSG 患者预后的因素。结论：混合有上皮样细胞型的 LCSG 预后较单纯肉瘤样细胞型差；年龄、肿瘤大小和组织学类型是影响 LCSG 患者预后的因素。%Objective:To investigate the clinicopathologic characteristics and prognosis of lung carcinoma with spindle /giant cells(LCSG).Methods:From september 1985 to July 2009,clinicopathologic records of 28 patients with LCSG were reviewed and analyzed.Kaplan -Meier method was used for survival analysis.Cox proportional haz-ards model was used for prognostic analysis.Results:In 28 patients there were 22 male and 6 female with median age of 60(33 ~73)years old,8 in stageⅠ,7 stage Ⅱ,11 stage Ⅲ and 2 stage Ⅳ in pathologic TNMstage.Of the 11 ca-ses of lung carcinoma with spindle cells,2 were exclusive spindle cell carcinoma,9 were mixed with epithelial compo-nents,such as squamous cell carcinoma in 5 cases,adenocarcinoma in 3 cases,adenosquamous and large cell carcino-ma in 1 case.Of the 17 cases of lung carcinoma with giant cells,13 were exclusive giant cell carcinoma,4 were mixed with epithelial components,such as squamous cell carcinoma in 1 case and adenocarcinoma in 3 cases.The median survival time was shorter in mixed epithelioid cell type than single sarcomatous carcinoma(8.0 months vs 22.8 months,P =0.022).Age(P =0.002),tumor size (P =0 .005 ),histologic type (P =0 .00 1 ),pTNM stage (P=0.015),T stage(P =0.008),N stage(P =0.013)and M stage(P =0.000)were prognostic factors of LCSG by univariate analysis.Conclusion:LCSG with mixed epithelioid cells had worse prognosis than with single sarcomatous cells.Age,tumor size and histologic type were prognostic factors of LCSG.