肺肉瘤样癌的临床特点和预后分析

发布时间：2019-05-26 20:01

【摘要】：目的:目前肉瘤样肺癌为一种比较罕见恶性程度较高的肿瘤。近年来肺肉瘤样癌发病率不断攀升,从而引起了胸外科医师的广泛关注,对其临床特征的研究已成为近年来的研究热点。本研究拟对肺肉瘤样癌的临床特征进行研究,探究临床特征与预后的关系。方法:收集河北医科大学第四医院收治的手术治疗的50名肺肉瘤样癌的患者,其中男性40名,女性10名。患者年龄在24-75岁之间,中位年龄为62岁。患者多因胸、背部疼痛,咳嗽咳痰,痰中带血或咳血为初次症状前来就诊。病变位于右肺上叶23例,左肺上叶11例,右肺下叶8例,左肺下叶、右肺中叶各有4例患者。全组患者影像学表现均为单一的孤立病灶,无远处器官的转移。多数患者术前均未确诊,为术后石蜡标本病理确诊。患者中50例行手术治疗,其中48例行肺叶切除术,2例行全肺切除术。27例患者术后给予辅助化疗,6例予以辅助放疗。使用SPSS 21.0统计软件对患者生存率进行统计学分析。P0.05统计学有意义。Kaplan-Meier法进行生存分析,Cox风险模型对患者预后进行单因素以及多因素分析。随访截止到2016年12月,中位其随访的时间为38个月。结果:本研究总体3年生存率约38.0%,5年生存率为14.0%。1)性别因素,5年生存率中统计学无差别(P=0.128)。2)年龄大于60岁组与小于等于60岁组5年生存率无统计学差异(P=0.731)。3)肿瘤直径小于等于5.0cm及直径大于5cm的患者5年生存率差异均有统计学意义(P=0.000)4)有无淋巴结的转移的患者5年生存率差异有意义,统计学有意义(P=0.000)。5、TNM分期对预后的影响,统计学有意义(P=0.002)。COX比例风险回归单因素分析:肿瘤大小(P=0.000),淋巴结转移情况(P=0.000),TNM分期(P=0.001)为有意义。而性别、年龄(P=0.128),(P=0.731)无统计学意义。Cox多因素分析中,淋巴结转移情况(P=0.003),TNM分期(P=0.000)为独立影响预后的因素。全组共有50名患者,对50例有随访条件的患者进行跟踪随访。当中有43名患者死亡,7名患者仍在生存,其术后总体5年生存率为14.0%。结论:年龄、性别、术后5年生存率无相关意义。患者淋巴结是否转移、TNM分期、肿瘤大小等因素对生存率有较明显的影响。
[Abstract]:Objective: at present, sarcoid lung cancer is a rare malignant tumor. In recent years, the incidence of pulmonary sarcomatoid carcinoma has been rising, which has aroused widespread concern of thoracic surgeons, and the study of its clinical features has become a hot research topic in recent years. The purpose of this study was to study the clinical features of pulmonary sarcomatoid carcinoma and to explore the relationship between clinical features and prognosis. Methods: fifty patients with pulmonary sarcomatoid carcinoma were treated surgically in the fourth Hospital of Hebei Medical University, including 40 males and 10 females. The age of the patient was between 24 and 75 years old, with a median age of 62 years. Most of the patients came to see the doctor because of chest, back pain, cough and expectoration, sputum with blood or cough blood as the first symptom. The lesions were located in the upper lobe of the right lung (23 cases), the upper lobe of the left lung (11 cases), the lower lobe of the right lung (8 cases), the lower lobe of the left lung (4 cases) and the middle lobe of the right lung (4 cases). The imaging findings of the patients were single isolated lesions and no distant organ metastasis. Most of the patients were not diagnosed before operation, which were confirmed by pathology of paraffin specimens after operation. 50 cases were treated surgically, including 48 cases of lobectomy and 2 cases of total pneumonectomy. 27 cases were treated with adjuvant chemotherapy and 6 cases with adjuvant radiotherapy. SPSS 21.0 statistical software was used to analyze the survival rate of patients. P 0.05 was statistically significant. Kaplan-Meier method was used for survival analysis, and Cox risk model was used to analyze the prognosis of patients by univariate and multivariate analysis. The follow-up period ended December 2016, with a median follow-up period of 38 months. Results: the overall 3-year survival rate and 5-year survival rate were 38.0% and 14.0%, respectively. There was no significant difference in 5-year survival rate (P 鈮，

本文编号：2485597