肺神经内分泌肿瘤42例临床报道

发布时间：2018-05-27 22:10

  本文选题：神经内分泌肿瘤 + 肺癌　； 参考：《山东大学》2017年硕士论文

【摘要】：目的:肺神经内分泌肿瘤(PNET)发生于支气管粘膜上皮的嗜银细胞,是一类具有相近的病理形态、超微结构、免疫组化以及分子特征的恶性肿瘤,约占所有肺癌的20%。近年来其发病率以及死亡率逐年不断地上升,随着对该疾病的认识不断深入,现如今已成为多学科领域的研究热点。本文通过对PNET的病理特点、临床表现、辅助检查、诊断标准、治疗方法及预后等进行整理和分析,旨在提高对此类疾病的认识和诊治水平。方法:回顾性统计山东省立医院胸外科自2010年1月一2016年12月收治的42例肺神经内分泌肿瘤病人的临床病例资料,进行整理、统计和分析。结果:本组42例患者中,有27例实施了手术治疗,其中18例病人施行了肺叶切除术,7例病人施行了单侧全肺的切除术,2例病人实施了肺楔形或肺段切除术;同时,采用了新辅助化疗的病人有5例,单纯手术的有6例,手术+术后辅助化疗的病人有16例。此外,15例病人仅仅进行了单纯性的化疗,采用的药物方案为EP方案(顺铂+依托泊苷)。术后病理结果:根据WHO(世界卫生组织)2004年病理诊断标准,SCLC有31例,LCNEC有7例,TC有3例,AC有1例;根据2010年AJCC(美国抗癌联合会)发布的第七版的肿瘤TNM分期标准,Ⅰ期病人有7例,Ⅱ期病人有11例,Ⅲ期病人有14例,Ⅳ期病人有10例。本组42例患者均通过电话随访,共随访40例,失访2例,随访时间从2016年1月至2016年12月。截至所有病人电话随访结束,本组所有42例PNET病人的OS中最短者为2个月,最长者为80个月,平均OS为19个月。结论:PNET约占所有原发性肺部恶性肿瘤的1/5,可分为4个亚组:典型类癌(TC)、非典型类癌(AC)、大细胞神经内分泌癌(LCNEC)以及小细胞肺癌(SCLC)。SCLC最常见,其次LCNEC,类癌较少见。常见的临床表现有咳嗽、咯血、阻塞性肺炎等症状,少数可伴发副瘤综合征如异位抗利尿激素分泌异常综合征(SIADH)、Cushing,s综合征、Lambert-Eaton综合征(LEMS)等。PNET的不同种类亚组在影像学中的表现不同。手术切除是治疗类癌的最主要的手段,局限期小细胞肺癌的标准治疗是早期胸部放疗联合EP方案化疗,预防性应用脑照射。TC预后较好,AC和LCNEC的预后较差,SCLC的预后最差。
[Abstract]:Objective: lung neuroendocrine tumor (PNET) is a kind of malignant tumor with similar pathological morphology, ultrastructure, immunohistochemistry and molecular characteristics, which accounts for about 20% of all lung cancer. In recent years, the morbidity and mortality rate have been increasing year by year. With the deepening of the understanding of the disease, it has become a research hotspot in multi-disciplinary field. In this paper, the pathological features, clinical manifestations, auxiliary examination, diagnostic criteria, treatment methods and prognosis of PNET were analyzed in order to improve the understanding, diagnosis and treatment of these diseases. Methods: the clinical data of 42 patients with lung neuroendocrine tumors admitted from January 2010 to December 2016 in the Department of Thoracic surgery in Shandong Provincial Hospital were analyzed retrospectively. Results: of the 42 patients, 27 received surgical treatment, 18 underwent lobectomy, 7 underwent unilateral total lung resection and 2 underwent wedge or segmental lung resection. There were 5 cases of neoadjuvant chemotherapy, 6 cases of simple operation and 16 cases of postoperative adjuvant chemotherapy. In addition, only 15 patients underwent simple chemotherapy with EP regimen (cisplatin etoposide). Postoperative pathological results: according to WHO (World Health Organization) 2004 pathological diagnosis criteria, 31 cases of LCNEC were diagnosed, 7 cases of TC, 3 cases of AC, 1 case of AC, and 7 cases of stage I patients according to the seventh edition of cancer TNM staging standard published by AJCC (American Anticancer Federation) in 2010. There were 11 cases of stage 鈪，

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