肺混合型腺癌中各主要构成亚型不同预后的比较

栾焕玲; 孙蕾娜; 郭燕; 董娜; 战忠利; 孙保存

doi:10.3969/j.issn.1000-8179.2011.01.007

摘要: 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（bron?chioloalveolar 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29.4%，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。

Abstract: Comparison of Prognosis for Mixed-Adenocarcinoma of the Lung among Various MajorSubtypesHuanling LUAN, Leina SUN, Yan GUO, Na DONG, Zhongli ZHAN, Baocun SUNCorrespondence to: Zhongli ZHAN, E-mail: lizhong1952@163.comDepartment of Pathology, Cancer Institute and Hospital of Tianjin Medical University, Tianjin 300060, ChinaThis work was supported by the National Natural Science Foundation of China (No.30770828)Abstract Objective: To compare the clinicopathologic and prognostic factors of the mixed-adenocarcinoma of thelung ( MACL ) among major mixed-subtypes. Methods: Data from 202 MACL patients who underwent surgery between Jan-uary 2004 and December 2006 were reviewed. The results of the pathological diagnosis were rechecked to make sure themajor mixed-subtypes of the tumor were classified correctly. Based on the 2004 WHO histological classification of lung can-cer, 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 sig-nificant difference in sex, age and smoking history among the 5 groups ( P > 0.05 ), nevertheless, significant difference wasin found in the symptoms at clinic visits, lymph node metastasis, N staging, T staging, tumor size, clinical TNM staging, andpostoperative recurrence and metastasis among the 5 groups ( P < 0.05 ). The highest rates of nodal metastasis and post-operative recurrence and metastasis were found in the group with papillary adenocarcinoma. The 3-year survival rateswere 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 grouphad the most favorable prognosis, and the MAC group had the poorest, while the other 3 groups were in between. Conclu?sion: There are distinct clinicopathologic features and different clinical prognosis for the 5 major subtypes of mixed adeno-carcinoma of the lung. Successful diagnosis of the mixed-subtype is critical for guiding clinical treatment and establishing aprognosis.Keywords Mixed-adenocarcinoma of lung (MACL); Subtype; Prognosis