298例肺癌合并肺结核回顾性临床分析

刘宇; 田野; 蔡勇; 盛兆瑛; 梁世雄

doi:10.3969/j.issn.1000-8179.2018.17.542

298例肺癌合并肺结核回顾性临床分析

doi: 10.3969/j.issn.1000-8179.2018.17.542

刘宇^①, ,,
田野^②,
蔡勇^①,
盛兆瑛^①,
梁世雄^①

①.
同济大学附属上海市肺科医院放疗科（上海市200433）
②.
苏州大学附属第二医院放疗科

详细信息

作者简介:
刘宇专业方向为肺癌诊断和综合治疗。E-mail：johnyuliu@sina.com

通讯作者:
刘宇 johnyuliu@sina.com

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- 文章访问数: 85
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- 被引次数: 0
出版历程
- 收稿日期: 2018-05-25
- 修回日期: 2018-08-08
- 刊出日期: 2018-09-15

Retrospective clinical analysis of 298 cases of lung cancer complicated with pulmonary tuberculosis

Liu Yu^{①
, ,},
Tian Ye^②,
Cai Yong^①,
Sheng Zhaoying^①,
Liang Shixiong^①

①.
Department of Radiotherapy, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai 200433, China
②.
Department of Radiotherapy, The Second Hospital Affiliated to Suzhou University, Suzhou 215004, China

More Information

Corresponding author: Yu Liu; E-mail: johnyuliu@sina.com

摘要

摘要: 目的分析肺癌合并肺结核的临床特点，以便早期识别肺癌合并肺结核患者。方法对同济大学附属上海市肺科医院2005年2月至2015年2月确诊的298例肺癌合并肺结核患者的临床表现、肺癌与肺结核病灶的关系、确诊时间、病理类型、确诊方法进行回顾性分析。结果肺癌合并肺结核患者以痰中带血为其常见的临床特征，CT影像以双肺上叶结节多见，部分病灶呈团块样病变；肺结核与肺癌病灶在同侧同叶37例（12.4%），病灶在肺叶不同侧138例（46.3%），病灶在肺叶部分重叠123例（41.3%）；已有肺结核病史后诊断肺癌者120例（40.3%），已有肺癌病史后诊断肺结核者28例（9.4%）；2种疾病同时诊断者150例（50.3%），平均确诊时间为10.9个月~10.5年；病理类型以非小细胞肺癌为主，均通过痰检测癌细胞和纤维支气管镜刷检获得明确诊断。结论肺癌合并肺结核患者具有一定的临床特点和CT影像特征，应及早明确诊断，对2种疾病进行早期同时治疗，以便获得较好的疗效。
- 肺肿瘤 /
- 肺结核 /
- 临床分析
Abstract: Objective To investigate the clinical characteristics and computed tomography (CT) features of patients with lung cancer complicated with pulmonary tuberculosis. Methods We retrospectively analyzed these data, such as those on clinical characteristics, relationship between cancer lesions and tuberculosis focus, time of confirmed diagnosis, pathological type of lung cancer, and diagnostic methods, of 298 patients with pulmonary tuberculosis complicated with lung cancer who were admitted to Shanghai Pulmonary Hospital between February 2000 and February 2015. Results Pulmonary tuberculosis complicated with lung cancer was more common in old male patients. Blood-stained sputum was the main clinical characteristic in these patients, and CT showed that most nodular lesions were localized in the upper lobe. Some lesions presented as masses. The number of patients with lesions localized in the same lobe of the ipsilateral lung was 37 (12.4%, 37/298). The lesions of pulmonary tuberculosis and lung cancer were localized in different lobes in 138 cases (46.3%, 138/ 298). In 123 (41.3%, 123/298) cases, some lesions of pulmonary tuberculosis and lung cancer partially overlapped. There were 120 patients diagnosed with lung cancer after pulmonary tuberculosis was confirmed, and 28 patients were diagnosed with pulmonary tuberculosis after lung cancer was confirmed. One hundred and fifty patients were diagnosed with pulmonary tuberculosis and lung cancer within no more than two months. The mean time of confirmed diagnosis was 10.9-126 months. The major pathological type was non-small cell lung cancer. Sputum examination and fiberoptic bronchoscopic brushing were primary methods to detect tumor cells. Conclusions Patients with pulmonary tuberculosis complicated with lung cancer presented with some special clinical characteristics and CT features. Earlier diagnosis may contribute to prompt treatment and improved prognosis synchronously.
- lung neoplasma /
- tuberculosis /
- clinical analysis

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表 1 肺癌合并肺结核临床特征 n

表 2 肺癌病理类型与肺结核部位的关系 n

参考文献(25)

[1]	Takeda M, Sakai K, Hayashi H, et al. Clinical characteristics of nonsmall cell lung cancer harboring mutations in exon 20 of EGFR or HER2[J]. Oncotarget, 2018, 9(30):21132-21140. http://d.old.wanfangdata.com.cn/Periodical/zhblx200912013
[2]	陈万青, 左婷婷, 郑荣寿, 等.2013年中国肺癌发病与死亡分析[J].中华肿瘤杂志, 2017, 39(10):795-800. doi: 10.3760/cma.j.issn.0253-3766.2017.10.015
[3]	Wu CY, Hu HY, Pu CY, et al. Pulmonary tuberculosis increases the risk of lung cancer: a population- based cohort study[J]. Cancer, 2011, 117(3):618-624. doi: 10.1002/cncr.v117.3
[4]	赵铭, 陈晓峰, 刘鸿程, 等.肺结核合并肺癌的危险因素及预后分析[J].实用医学杂志, 2010, 26(11):1951-1953. doi: 10.3969/j.issn.1006-5725.2010.11.033
[5]	中华人民共和国国家卫生和计划生育委员会.肺结核诊断[J].传染病信息, 2017, 30(6):1-12. http://d.old.wanfangdata.com.cn/Periodical/shyxjyzz201605020
[6]	Beyhan Çakara, Aydın Çiledağ. Evaluation of coexistence of cancer and active tuberculosis; 16 case series[J]. Respir Med Case Rep, 2018, 23:33-37. http://europepmc.org/articles/PMC5709315/
[7]	Libshitz HI, Pannu HK, Elting LS, et al. Tuberculosis in cancer patients: an update[J]. J Thorac Imag, 1997, 12(1):41-46. doi: 10.1097/00005382-199701000-00006
[8]	Fijołek J, Wiatr E, Polubiec-Kownacka M, et al. Pulmonary tuberculosis mimicking lung cancer progression after 10 years of cancer remission[J]. Adv Respir Med, 2018, 86(2):92-96. http://europepmc.org/abstract/MED/29709049
[9]	Yao D, Zhang L, Wu PL, et al. Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study[J]. BMC Cancer, 2018, 18(1):281. http://d.old.wanfangdata.com.cn/Periodical/zhcmj201815006
[10]	Unsal E, Koksal D, Cimen F, et al. Analysis of patients with hemoptysis in a reference hospital for chest diseases[J]. Tuberk Toraks, 2006, 54(1):34-42. http://europepmc.org/abstract/MED/16615016
[11]	马录萍, 杨奇帅.肺结核咯血161例临床分析[J].中国医学创新, 2012, 9(14):96-97. doi: 10.3969/j.issn.1674-4985.2012.14.062
[12]	Inage T, Nakajima T, Yoshino I, et al. Early Lung Cancer Detection[J]. Clin Chest Med, 2018, 39(1):45-55. doi: 10.1016/j.ccm.2017.10.003
[13]	Kim YI, Goo JM, Kim HY, et al. Coexisting bronchogenic carcinoma and pulmonary tubereulosis in the same lobe: radiologic findings and clinical significance[J]. Korean J Radiol, 2001, 2(3):138-144.
[14]	Liang HY, Li XL, Yu XS, et al. Facts and fiction of the relationship between preexisting tuberculosis and lung cancer risk: a systematic review[J]. Int J Cancer, 2009, 125(12):2936-2944. doi: 10.1002/(ISSN)1097-0215
[15]	Brenner DR, McLaughlin JR, Hung RJ. Previous lung diseases and lung cancer risk: a systematic review and meta- analysis[J]. PLoS One, 2011, 6:e17479. doi: 10.1371/journal.pone.0017479
[16]	Kim HR, Hwang SS, Ro YK, et al. Solid-organ malignancy as a risk factor for tuberculosis[J]. Respirology, 2008, 13(3):413-419. http://www.ncbi.nlm.nih.gov/pubmed/18399865
[17]	Nalbandian A, Yan BS, Pichugin A, et al. Lung carcinogenesis induced by chronic tuberculosis infection: the experimental model and genetic control[J]. Oncogene, 2009, 28(17):1928-1938. doi: 10.1038/onc.2009.32
[18]	De Luigi G, Mantovani A, Papadia M, et al. Tuberculosis-related choriocapillaritis (multifocal-serpiginous choroiditis):follow-up and precisemonitoring of therapy by indocyanine green angiography[J]. Int Ophthalmol, 2012, 32(1):55-60. doi: 10.1007/s10792-011-9508-y
[19]	Mantovani A, Sica A. Macrophages, innate immunity and cancer: balance, tolerance, and diversity[J]. Curr Opin Immunol, 2010, 22 (2):231-237. http://d.old.wanfangdata.com.cn/NSTLQK/NSTL_QKJJ0217585515/
[20]	Liang HY, Li XL, Yu XS, et al. Facts and fiction of the relationship between preexisting tuberculosis and lung cancer risk: a systematic review[J]. Int J Cancer, 2009, 125(12):2936-2944.
[21]	李成海, 邱万成, 周新华, 等.71例肺结核并发肺癌患者的CT表现特征及临床病理分析[J].中国防痨杂志, 2017, 39(6):576-580. doi: 10.3969/j.issn.1000-6621.2017.06.007
[22]	Ventsiavichius V, Tsitsenas S, Tikuĭshis R. Potentialities of surgical treatment for concomitance of pulmonary tuberculosis and lung cancer[J]. Probl Tuberk Bolezn Legk, 2007, (5):32-36. http://europepmc.org/abstract/MED/17598460
[23]	Kim H, Kim SJ, Lee SH, et al. Usefulness of melanoma antigen (MAGE) gene analysis in tissue samples from percutaneous needle aspiration biopsy of suspected lung cancer lesions[J]. Lung Cancer, 2010, 69(3):284-288. http://www.ncbi.nlm.nih.gov/pubmed/20064673
[24]	Kim DK, Lee SW, Yoo CG, et al. Clinical characteristics and treatmentresponses of tuberculosis in patients with malignancyreceiving anticancer chemotherapy[J]. Chest, 2005, 128(4):2218-2222. doi: 10.1378/chest.128.4.2218
[25]	Sfyridis PG, Kapetanakis EI, Baltayiannis NE, et al. Bronchial stump buttressing with an intercostal muscle flap indiabetic patients[J]. Ann Thorac Surg, 2007, 84(3):967-971. doi: 10.1016/j.athoracsur.2007.02.088