肺神经内分泌肿瘤120例临床病例分析

发布时间：2018-05-29 02:30

  本文选题：肺神经内分泌肿瘤 + 类癌　； 参考：《青海大学》2017年硕士论文

【摘要】：目的:探讨肺神经内分泌肿瘤的临床病理特征,并分析临床病理特征与预后关系。方法:收集2014年12月1日至2017年1月31日期间青海大学附属医院、青海省人民医院收治的120例经病理确诊的肺神经内分泌肿瘤患者完整病历资料,将患者的临床病理特征(年龄、性别、吸烟状况、临床表现、组织病理及免疫组化、分期、影像特点、肿瘤标志物、治疗方案)进行回顾性分析,对所有病例进行随访。计数资料的描述用率或构成比,组间率的比较采用X2检验;生存曲线采用Kaplan-Meier法计算,Log-Rank法进行影响预后单因素分析,COX模型进行影响预后多因素分析,检验水准α=0.05.结果:1、120例肺神经内分泌肿瘤患者一般特征:男性78例,女性42,男女比例为1.86:1。典型类癌15例,不典型类癌17例,大细胞神经内分泌癌10例,小细胞肺癌78例。年龄区间30-82岁,中位年龄58岁。吸烟者68例,均为男性,吸烟指数600者43例。肿瘤家族史者8例。肿瘤d3cm者48例,d≤3cm者72例。未见淋巴结肿大者33例,有淋巴结肿大者87例。2、临床特征:症状无明显特异性,以咳嗽发生率最高,为64.2%,其他症状多为呼吸系统常见症状:典型类癌、不典型类癌、小细胞肺癌常见症状为咳嗽、咳痰、胸闷、气憋等。部分大细胞神经内分泌癌无症状,有症状者也多为呼吸系统常见症状。3、病理特征:入组患者中有肿瘤标志物检测报告单者共98例,13项肿瘤标志物不同程度升高,以NSE、Progrp升高率最多;91例患者行免疫组化检测且有详细结果,80例患者行CgA检测,阳性率:37.5%。91例行SyN检测,阳性率:72.5%。58例行CD56检测,阳性率:77.6%。70例行TTF-1检测,阳性率72.8%.4、治疗与预后:手术治疗者50例,放、化疗者97例,仅行支持治疗者3例.单因素分析示:TNM分期(P=0.009)、手术(P=0.000)、放化疗(P=0.025)以及组织类型(P=0.002)对生存时间有重要影响。多因素分析结果示:手术(P=0.000)、放化疗(P=0.018)、组织类型(P=0.022)为影响预后独立因素.结论:1、性别、年龄、吸烟状况与肺神经内分泌肿瘤预后无关。2、肺神经内分泌肿瘤临床表现无特殊性,需结合影像资料、肿瘤标志物、细胞形态及免疫组化综合诊断。TC、AC与SCLC临床表现以咳嗽、咳痰、胸闷、气憋等常见症状为主,部分LCNEC无症状。3、手术是TC、AC、LCNEC重要的治疗手段之一,手术对于分期早、病灶局限的SCLC也是可选的方法之一。有淋巴结转移的TC、AC可行放化疗,放化疗是SCLC首选治疗方案,放化疗在LCNEC也表现为获益。4、肺神经内分泌肿瘤类型不同预后差异较大,小细胞肺癌预后最差。5、手术、放化疗、组织类型是影响预后的重要因素。
[Abstract]:Objective: to investigate the clinicopathological features of neuroendocrine tumors of the lung and to analyze the relationship between clinicopathological features and prognosis. Methods: from December 1, 2014 to January 31, 2017, 120 patients with lung neuroendocrine neoplasms diagnosed pathologically in Qinghai Provincial people's Hospital and affiliated Hospital of Qinghai University were collected. The clinicopathological features (age, sex, smoking status, clinical manifestation, histopathology and immunohistochemistry, staging, imaging features, tumor markers, treatment plan) of the patients were analyzed retrospectively. All cases were followed up. The descriptive rate or composition ratio of counting data was compared by X2 test, and the survival curve was calculated by Kaplan-Meier method. The Cox model was used to analyze the multiple factors affecting the prognosis, and the test level was 伪 0.05. Results the general characteristics of 1: 120 patients with lung neuroendocrine tumors were 78 males and 42 females, with a ratio of 1.86: 1. There were 15 cases of typical carcinoid, 17 cases of atypical carcinoid, 10 cases of large cell neuroendocrine carcinoma and 78 cases of small cell lung cancer. The age range was 30-82 years old, the median age was 58 years old. There were 68 smokers, all of whom were male, and the smoking index was 600 (43 cases). 8 cases had family history of tumor. D3cm was found in 48 cases (d 鈮，

本文编号：1949152