79例肺原发性粘液腺癌的临床分析

发布时间：2018-01-24 11:31

  本文关键词： 肺原发性粘液腺癌 临床特征 预后 影响因素　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析肺原发性粘液腺癌(Primary Pulmonary Mucinous(Colloid)Adenocarcinoma PPMA)的临床表现、影像学特征、病理特点、治疗方式及其预后的重要影响因素。方法:回顾性分析大连医科大学附属第一医院胸外科2011年1月至2016年1月手术的并经术后病理证实且随访资料完整的79例PPMA患者资料,记录了基本一般情况主要包括性别、年龄、临床症状、吸烟情况、肿瘤家族史、CEA、cyfra21-1、FVC,FVC%,FEV1,MVV,TNM分期,术前并发症情况等,CT表现包括肿瘤位置、肿瘤最大径、胸膜侵犯情况,淋巴结转移情况、脉管侵袭情况、特征性表现(分叶征、边缘毛刺征、厚壁偏心空洞、胸膜凹陷征、血管进入征、支气管充气征或空泡征),治疗情况包括手术方式(微创或者开放)、手术时间,胸腔闭式引流管留置时间,术中失血量、住院天数、术后并发症,术后辅助治疗方案等因素;以Kaplan-Meier法计算生存率、Log-rank进行生存率显著性检验进行单因素分析、Cox比例回归风险模型进行多因素分析,进而评价各因素对预后的影响。结果:79例肺原发性粘液腺癌,男性35例,女性34例,占我科同期经手术后证实肺癌的2.16%,其中单纯性的浸润性粘液腺癌39例(49.4%),微浸润粘液腺癌2例(2.5%),混合型粘液腺癌37例(46.8%),中央型肺癌3例,周围型肺癌76例,平均发病年龄为(62.04±8.82)岁,其中52例(65.8%)是由于体检时发现肺部阴影来就诊,36例(45.6%)至少出现一种临床症状,最常出现的临床症状是咳嗽、咳痰,胸闷,其中15例出现痰中带血,3例有胸腔积液,1例出现咳血;吸烟者15例,均为男性,癌胚抗原cea升高者16例,细胞角蛋白19片段cyfra21-1升高者39例,fvc平均值(2.87±0.76)l,fvc%平均值(84.80±14.62)%。fev1平均值(2.43±0.69)l。mvv平均值(94.19±34.19)l/min,tnm分期:其中i期59例(74.68%),ii期12例(15.19%),iii期7例(8.86%),iv期1例(1.3%)。肿瘤生长部位:其中左肺上叶10例(12.65%),左肺下叶22例(27.85%),右肺上叶13例(16.46%),右肺中叶5例(6.32%),右肺下叶27例(34.18%),肿瘤侵及右肺中下叶2例(2.5%)。病灶最大径8cm,最小径0.4cm。ct表现可见血管进入征70例(88.6%),分叶征42例(53.16%),周围可见毛刺征56例(70.89%),肿瘤内部可见支气管充气征30例(38.0%),空洞征12例(15.19%),周围可见紧邻胸膜牵拉征52例(65.82%)。79例患者全部经过手术治疗,术后病理证实淋巴结转移者4例,胸膜侵犯者52例,脉管侵袭者10例,其中其中微创胸腔镜手术63(79.75%),开放手术17例(21.52%)。手术时间平均值(2.4±1.06)h,术中出血量平均为(36.01±34.65)ml,引路管引流平均为(3.90±2.05)d,住院天数平均值(11.10±4.41)d,术后25例行手术联合术后化疗,5例行手术联合术后放化疗和免疫治疗。其中1例患者术后6个月出现头颅,全身骨(腰椎)转移,于术后10个月死亡,其中1例术后联合4期化疗1年后出现双肺、全身骨转移,于术后44个月死亡,其中1例术后联合化疗后25个月出现头颅、胸部淋巴结转移,现接受放化疗,仍然健在。55例在随访结束期间,继续存活并且复查证实无复发或转移,生活状态良好。全部患者的1年、3年、5年生存率分别为94%、74%、71%,中位生存期为60个月。单因素分析显示:确诊时临床tnm分期(p=0.002)、支气管充气征(p=0.019)、手术方式(p=0.017)是影响预后的重要因素,其他因素:性别(p=0.075)、年龄(p=0.349)、临床症状(p=0.408)、吸烟情况(p=0.123)、cea(p=0.082)、cyfra21-1(p=0.559)、cea和cyfra21-1联合(p=0.707)、fvc(p=0.594),fvc%(p=0.744),fev1(p=0.834),mvv(p=0.243),术前并发症情况(p=0.586),ct表现包括肿瘤位置(p=0.077)、肿瘤最大径(p=0.122)、胸膜侵犯情况(p=0.682),淋巴结转移情况(p=0.114)、脉管侵袭情况(p=0.624)、分叶征(p=0.210)、边缘毛刺征(p=0.931)、厚壁偏心空洞(p=0.193)、胸膜凹陷征(p=0.812)、血管进入征(p=0.970)、手术时间(p=0.251),胸腔闭式引流管留置时间(P=0.496),术中失血量(P=0.740)、住院天数(P=0.139)、术后并发症(P=0.797),术后辅助治疗方案(P=0.407)均不是影响预后的因素;Cox回归多因素分析显示:无影响预后的独立因素。结论:1.肺原发性粘液腺癌临床表现无明显特异性。2.影像学主要表现为:周围型为主,实性结节居多,好发于双肺下叶,支气管充气征是特征性影像学表现。3.TNM分期、支气管充气征、手术方式是影像预后的重要因素,无明显独立影响因素
[Abstract]:Objective: to analyze the primary lung mucinous adenocarcinoma (Primary Pulmonary Mucinous (Colloid) Adenocarcinoma PPMA) of the clinical manifestations, imaging features, pathological characteristics, important factors influencing the way of treatment and prognosis. Methods: a retrospective analysis from January 2011 to January 2016 in Department of thoracic surgery surgery the First Affiliated Hospital of Dalian Medical University, confirmed by pathology and 79 cases the data of PPMA patients with complete follow-up data, records the basic general situation including gender, age, clinical symptoms, smoking status, family history, tumor CEA, CYFRA21-1, FVC, FVC%, FEV1, MVV, TNM staging, preoperative complications, CT findings including the location of the tumor, the maximum tumor diameter, pleural invasion. Lymph node metastasis, vascular invasion, features (lobulation, edges, thick wall eccentric hole, pleural indentation, vascular access sign, air bronchogram or vacuole sign), treatment Treatment including surgery (minimally invasive or open), operation time, closed thoracic drainage tube indwelling time, intraoperative blood loss, hospitalization time, postoperative complications, postoperative adjuvant treatment and other factors were calculated by Kaplan-Meier method; the survival rate, survival rate of Log-rank was significant test was used for univariate analysis, the proportion of Cox regression model for multivariate analysis, and evaluate the effect of various factors on the prognosis. Results: 79 cases of primary lung mucinous adenocarcinoma, 35 males, 34 females, 2.16% confirmed by surgical lung cancer in our department during the same period, the single pure invasive mucinous adenocarcinoma in 39 cases (49.4%) micro invasive mucinous adenocarcinoma, 2 cases (2.5%), 37 cases of mixed type mucinous adenocarcinoma (46.8%), 3 cases of central lung cancer, 76 cases of peripheral lung cancer, the average age was (62.04 + 8.82) years old, of which 52 cases (65.8%) is due to physical examination found that 36 cases were pulmonary shadows, (45.6%) at least 鐜颁竴绉嶄复搴婄棁鐘，

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