肺混合型腺癌中各主要构成亚型不同预后的比较

摘要

Objective: To compare the clinicopathologic and prognostic factors of the mixed-adenocarcinoma of the lung ( MACL ) among major mixed-subtypes.Methods: Data from 202 MACL patients who underwent surgery between January 2004 and December 2006 were reviewed.The results of the pathological diagnosis were rechecked to make sure the major mixed-subtypes of the tumor were classified correctly.Based on the 2004 WHO histological classification of lung cancer, the cases were divided into 5 groups: the bronchiolo-alveolar carcinoma ( BAC ) group, the acinar carcinoma ( AAC ) group, the solid carcinoma ( SAC ) group, the papillary carcinoma ( PAC ) group and the mucinous carcinoma ( MAC ) group.The Kaplan-Meier method was used for survival analysis.Results: Statistical analysis showed that there was no significant difference in sex, age and smoking history among the 5 groups ( P ＞ 0.05 ), nevertheless, significant difference was in found in the symptoms at clinic visits, lymph node metastasis, N staging, T staging, tumor size, clinical TNM staging, and postoperative recurrence and metastasis among the 5 groups ( P ＜ 0.05 ).The highest rates of nodal metastasis and postoperative recurrence and metastasis were found in the group with papillary adenocarcinoma.The 3-year survival rates were 78.4％ for the BAC group, 52.5％ for the AAC group, 48.3％ for the SAC group, 47.8％ for the PAC group and 29.4％ for the MAC group, with significant difference ( P = 0.000 ).Kaplan-Meier survival analysis revealed that the BAC group had the most favorable prognosis, and the MAC group had the poorest, while the other 3 groups were in between.Conclusion: There are distinct clinicopathologic features and different clinical prognosis for the 5 major subtypes of mixed adenocarcinoma of the lung.Successful diagnosis of the mixed-subtype is critical for guiding clinical treatment and establishing a prognosis.%目的:探讨肺混合型腺癌(lung mixed-adenocarcinoma,LMAC)构成中各主要混合亚型不同,临床病理学特点及预后有无差异.方法:收集天津医科大学附属肿瘤医院自2004年1月至2006年12月间,经手术切除、病理证实的肺混合型腺癌202例,重新审阅肿物病理切片,判定其主要混合亚型,并依据2004年WHO最新肺癌组织学分类标准分为五组:细支气管肺泡癌(bronchioloalveolar carcinoma,BAC)组、腺泡样腺癌组、实性腺癌伴黏液产生组、乳头状腺癌组以及黏液腺癌组.回顾性分析临床资料并随访至2009年12月.采用Kaplan-Meier法进行生存分析.结果:统计结果显示五组间在性别、年龄、吸烟状态之间差异无显著性(P＞0.05),与就诊时有无症状、淋巴结转移、N分期、T分期、肿瘤大小、临床分期及术后是否复发转移之间差异具有显著统计学意义(P＜0.05).其中乳头状腺癌组淋巴结转移率和术后复发转移率最高.五组的3年生存率依次为78.4%、52.5%、48.3%、47.8%和2914%,差异具有显著统计学意义(P=0.000).Kaplan-Meier生存分析表明BAC组预后最好,黏液腺癌组预后最差,其余三组预后介于两者之间.结论:五组间在临床病理因素方面各具特点,且有着不同的临床预后.因此对肺混合型腺癌中主要混合亚型进行判定,对指导临床治疗及有效预测预后具有重要的意义.